Myocardial ischemia in ACS may progress to MI and is potentially life threatening. In addition, in patients with ACS, angina (including recurrent angina) is more likely to be reduced by revascularization than by medical therapy.26 A heart team approach to revascularization deci- sions, involving an interventional cardiologist and cardio- thoracic surgeon, is used in patients with unprotected left main or complex CAD. Calculation of SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) and STS scores is reasonable in these patients to guide the choice of revascularization.23,26,355 Factors that influence the choice of revascularization pro- cedure include the extent and complexity of CAD; short-term risk and long-term durability of PCI; operative mortality (which can be estimated by the STS score); diabetes mellitus; CKD; completeness of revascularization; LV systolic dys- function; previous CABG; and the ability of the patient to tol- erate and comply with DAPT. In general, the greater the extent and complexity of the multivessel disease, the more com- pelling the choice of CABG over multivessel PCI.23,26,356 358 In patients with NSTE-ACS, PCI of a culprit unprotected left main coronary artery lesion is an option if the patient is not a candidate for CABG.23,26 See Online Data Supplements 21 and 22 for additional information on myocardial revascularization. 5.1. Percutaneous Coronary Intervention 5.1.1. PCI General Considerations: Recommendation Class IIb 1. 