See Online Data Supplement 19 for additional information on comparison of early versus delayed angiography. Table 8. Factors Associated With Appropriate Selection of Early Invasive Strategy or Ischemia-Guided Strategy in Patients With NSTE-ACS Immediate invasive (within 2 h) Refractory angina Signs or symptoms of HF or new or worsening mitral regurgitation Hemodynamic instability Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy Sustained VT or VF Ischemia-guided strategy Low-risk score (eg, TIMI [0 or 1], Low-risk Tn-negative female patients Patient or clinician preference in the absence of high-risk features Early invasive (within 24 h) None of the above, but GRACE risk score >140 Temporal change in Tn (Section 3.4) New or presumably new ST depression Delayed invasive (within None of the above but diabetes mellitus Renal ) Reduced LV systolic function (EF <0.40) Early postinfarction angina PCI within 6 mo Prior CABG GRACE risk score 109 140; TIMI score 2 CABG indicates coronary artery bypass graft; EF, ejection fraction; GFR, glo merular filtration rate; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; LV, left ventricular; NSTE-ACS, non ST-elevation acute coronary syndrome; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarc tion; Tn, troponin; VF, ventricular fibrillation; and VT, ventricular tachycardia. Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e371 4.4.5. Subgroups: Early Invasive Strategy Versus Ischemia- Guided Strategy The TACTICS-TIMI (Treat Angina With Tirofiban and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction) 18 trial demonstrated a reduction in the 6-month endpoint of death or MI in older adults with ACS.138 Controversy exists over revas- cularization treatment differences between men and women with ACS. 