Selection for Coronary Angiography In contrast to noninvasive tests, coronary angiography provides detailed structural information for assessment of prognosis and appropriate management. When combined with LV angi- ography, it also provides an assessment of global and regional LV function. Coronary angiography is usually indicated in patients with NSTE-ACS who have recurrent symptoms or ischemia despite adequate medical therapy or who are at high risk as categorized by clinical findings (HF, serious ventricular arrhythmias), noninvasive test findings (significant LV dysfunc- tion with EF <0.40, large anterior or multiple perfusion defects or wall motion abnormalities on echocardiography, high-risk Duke treadmill score 11), high-risk TIMI or GRACE scores, or markedly elevated troponin levels. Patients with NSTE-ACS who have had previous PCI or CABG should also be considered for early coronary angiography, unless prior coronary angiog- raphy data indicate that no further revascularization is feasible. The general indications for coronary angiography and revascularization should be tempered by individual patient characteristics and preferences (a patient-centered approach). Patient and clinician judgments about risks and benefits are important for patients who might not be candidates for cor- onary revascularization, such as very frail older adults and those with serious comorbid conditions (eg, severe hepatic, pulmonary, or renal failure; active or inoperable cancer). See Online Data Supplement 20 for additional information on risk stratification. 5. Myocardial Revascularization Recommendations about coronary artery revascularization indications, benefits, and choice of revascularization proce- dure (PCI or CABG) for all anatomic subsets have been pub- lished in the 2011 PCI CPG,26 and the 2012 stable ischemic heart disease CPG and its 2014 focused The main difference between management of patients with stable ischemic heart disease and NSTE-ACS is a stronger impetus for revascularization in those with NSTE- ACS. Myocardial ischemia in ACS may progress to MI and is potentially life threatening. 