*Required for US facilities but may not be possible for all facilities worldwide. ACC indicates American College of Cardiology; IABP, intra-aortic balloon pump; IVUS, intravascular ultrasound; NCDR, National Cardiovascular Data Registry; PCI, percutaneous coronary intervention; SCAI, Society for Cardiovas- cular Angiography and Interventions; and STEMI, ST-elevation myocardial infarction. Adapted with permission from Dehmer et al.352 Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e595 related bleeding and complications.255,260,363 In a recent large RCT comparing radial and femoral access in patients with ACS undergoing PCI, there was no difference in the primary composite endpoint (death, MI, stroke, major bleeding), although there was a lower rate of vascular complications with the use of radial access.362 Radial artery access is particularly appealing in patients with coagulopathy, elevated international normalized ratio due to warfarin, or morbid obesity. 5.2. PCI in Specific Clinical Situations 5.2.1. UA/NSTEMI: Recommendations Class I 1. An early invasive strategy (ie, diagnostic angiogra- phy with intent to perform revascularization) is indicated in UA/NSTEMI patients who have refrac- tory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures).207,364,365 (Level of Evidence: B) 2. An early invasive strategy (ie, diagnostic angiography with intent to perform revascularization) is indicated in initially stabilized UA/NSTEMI patients (without serious comorbidities or contraindications to such pro- cedures) who have an elevated risk for clinical events.207,365 367 (Level of Evidence: A) 3. The selection of PCI or CABG as the means of revascularization in the patient with ACS should generally be based on the same considerations as those without ACS.53,156,207,368 (Level of Evidence: B) Class III: NO BENEFIT 1. 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. 