An early invasive strategy (ie, diagnostic angiogra- phy with intent to perform revascularization) is not recommended in patients with extensive comorbidi- ties (eg, liver or pulmonary failure, cancer) in whom (Level of Evidence: C) a. The risks of revascularization and comorbid con- ditions are likely to outweigh the benefits of revascularization, b. There is a low likelihood of ACS despite acute chest pain, or c. Consent to revascularization will not be granted regardless of the findings. The goals of coronary angiography and revascularization in UA/NSTEMI patients are to reduce the risk of death and MI and provide symptom relief. To improve prognosis, early risk stratification is essential for selection of medical and/or invasive treatment strategies. Indications for revasculariza- tion depend on the patient s clinical risk characteristics and coronary anatomy and are in general stronger in the presence of high-risk clinical presentation (eg, dynamic electrocardio- Table 6. SCAI Expert Consensus Document Requirements for Off-Site Surgical Backup 1. Interventional cardiologists establish a working relationship with cardiac surgeons at the receiving facility. 2. Cardiac surgeon must have privileges at the referring facility to allow review of treatment options as time allows. 3. Cardiac surgeon and receiving hospital agree to provide cardiac surgical backup for urgent cases at all hours and for elective cases at mutually agreed hours. 4. Surgeon and receiving facility ensure that patients will be accepted based on medical condition, capacity of surgeon to provide services at the time of request, and availability of resources. If this cannot be ensured before the start of an elective procedure, the case should not be done at this time. 5. Interventional cardiologists must review with surgeons the immediate needs and status of any patient transferred for urgent surgery. 6. Hospital administrations from both facilities endorse transfer agreement. 7. 