Complications occur more frequently in older patients with Length of stay averages 6 days longer in older patients than in patients <50 years of age, and discharge (to home [52%]) is less frequent than in younger patients.557 In a metaanalysis, off-pump CABG appeared to offer a poten- tially safer and more effective revascularization technique compared with on-pump CABG in older patients with NSTE- Older patients with NSTE-ACS with diabetes mellitus had a greater survival advantage with CABG.529 Evaluation tools can help identify older patients with NSTE-ACS whose risk and comorbidity profile predict mortality within 6 to 12 months and possibly guide a palliative approach.524 See Online Data Supplement 24 for additional information on older patients. 7.2. HF: Recommendations Class I 1. Patients with a history of HF and NSTE-ACS should be treated according to the same risk stratification guidelines and recommendations for patients without (Level of Evidence: B) 2. Selection of a specific revascularization strategy should be based on the degree, severity, and extent of CAD; associated cardiac lesions; the extent of LV dysfunction; and the history of prior revascu- (Level of Evidence: B) In patients with HF and NSTE-ACS, the plan of care should be implemented as in patients without HF using medical therapy and an early invasive approach, because patients with abnormal LV function are at increased risk of mortality and HF itself may be associated with elevated serum troponin in the presence or absence of obstructive CAD. After angiography, risk stratification can be used to select revascu- larization strategies. The effect of surgical revascularization on improving survival has been most clearly demonstrated in patients with both extensive CAD and LV dysfunc- Such patients should undergo testing to iden- tify the severity and extent of ischemia and should in general be referred for coronary angiography. 