These patients may not experience spontaneous ischemia during their hospitalization and need to be further risk stratified before discharge with a stress test (preferably, a submaximal stress test). This will help identify the high-risk patient who needs invasive angiography and possible revascularization, predominantly to mitigate recurrent ischemia/MI.11,12,138 141 A noninvasive stress test can be exercise-based or pharmacological, and the means for detecting ischemia may be via ECG alone or with an added imaging modality. Notably, many patients with AMI who are managed conservatively initially may cross over to undergo invasive coronary angiography, without undergoing a noninvasive stress test. Common clinical indications for resorting to coronary angiography during the same AMI hospitalization after an initial conservative management trial include, but are not limited to: spontaneous non-inducible ischemia among patients already treated with aggressive medical therapies; LVSD, where a high level of suspicion for left main or multi-vessel coronary artery disease exists. These aforementioned scenarios are to be differentiated (and excluded from the denominator) from those during which coronary angiography is performed in initially conservatively managed AMI patients because of a high-risk noninvasive stress test. Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Noninvasive testing for ischemia should be performed before discharge to assess the presence and extent of inducible ischemia in patients with STEMI who have not had coronary angiography and do not have high-risk clinical features for which coronary angiography would be warranted.138,140,141 (Class I, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. 