Patients with prior CABG and NSTE-ACS should receive antiplatelet and anticoagulant therapy according to GDMT and should be strongly considered for early invasive strategy because of their increased risk.143,145,177,178,189,190 (Class I, Level of Evidence: B) 5. Women with NSTE-ACS and high-risk features (eg, troponin positive) should undergo an early invasive strategy.172,173,178,191 (Class I, Level of Evidence: A) ACC indicates American College of Cardiology; ACS, acute coronary syndromes; AHA, American Heart Association; CABG, coronary artery bypass graft; ED, emergency department; GDMT, guideline-directed medical therapy; GRACE, Global Registry of Acute Coronary Events; MI, myocardial infarction; NSTE-ACS, non ST-elevation acute coronary syndrome; NSTEMI, non ST-elevation myocardial infarction; and TIMI, Thrombolysis in Myocardial Infarction. Appendix A. Continued 36 Short Title: QM-3: Therapeutic Hypothermia for STEMI Patients QM-3: STEMI: Therapeutic Hypothermia for Comatose STEMI Patients With Out-of-Hospital Cardiac Arrest Measure Description: Percentage of patients, age 18 y, with STEMI who become comatose after resuscitated out-of-hospital cardiac arrest (secondary to VF or pulseless VT) and who receive therapeutic hypothermia. Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who are comatose after resuscitated out-of-hospital cardiac arrest (VF or pulseless VT), who receive therapeutic hypothermia *Patients with STEMI equivalent on ECG may have: hyperacute T-wave changes, true posterior MI, multilead ST depression with coexistent ST elevation in lead aVR, characteristic diagnostic criteria in the setting of LBBB. 