Modified from Wright et al.6 Jneid et al 2012 UA/NSTEMI Focused Update 909 Appendix 6. Selection of Initial Treatment Strategy: Invasive Versus Conservative Strategy Generally Preferred Strategy Patient Characteristics Invasive Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy Elevated cardiac biomarkers (TnT or TnI) New or presumably new ST-segment depression Signs or symptoms of HF or new or worsening mitral regurgitation High-risk findings from noninvasive testing Hemodynamic instability Sustained ventricular tachycardia PCI within 6 mo Prior CABG High-risk score (eg, TIMI, GRACE) Mild to moderate renal dysfunction Diabetes mellitus Reduced LV function (LVEF 40%) Conservative Low-risk score (eg, TIMI, GRACE) Patient or physician preference in the absence of high-risk features CABG indicates coronary artery bypass graft; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; LV, left ventricular; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarction; TnI, troponin I; and TnT, troponin T. Reprinted from Anderson et al.4