In addition to risk factor modification, some studies support the benefit of imipramine, ranolazine, beta blockers, and/or ACE inhibitors to reduce adverse outcomes.687 Women with NSTE-ACS incur a higher rate of bleeding complications672,673 (Section 7.8) and renal failure. A risk score has been developed to attempt to reduce the bleeding risk in women with NSTE-ACS.688 The decision for an early invasive versus an ischemia-guided strategy in women with NSTE-ACS is based on a meta-analysis366 and post hoc gender analyses of clinical trials, including FRISC II, RITA-3, and TACTICS-TIMI 18.344,346,689 The Agency for Healthcare Research and Quality analysis of an early invasive versus ischemia-guided strategy345 provides further evidence that an early invasive strategy should be reserved for women with positive troponins, as shown in TACTICS-TIMI 18.346 Such women had a significant reduction of death and MI at 1 year with an early invasive versus ischemia-guided strategy. Women with NSTE-ACS and no elevation in troponin who underwent an early invasive strategy had a nonsignificant increase in events, as did women with a low-risk TIMI score (OR: 1.59 for early invasive versus ischemia-guided strategy), prompting the Class III recommendation in this CPG. The NCDR-ACTION registry reported increased com- plication rates of myocardial revascularization in women (https://www.ncdr.com/webncdr/action/). Women also have higher rates of contrast-induced nephropathy and vascular Despite having fewer high-risk angio- graphic lesions, a higher percentage of normal LV function, and up to 25% angiographically normal coronary arteries, women with NSTE-ACS have a paradoxically higher rate of persistent angina, reinfarction, functional decline, and depression after PCI.141,675,677,680,682 and a of DES for NSTE-ACS reported no gender differences in short- and long-term (up to 5 years) outcome, including target vessel revascularization, MACE, cardiac death, or MI. However, women were older and had more comorbidities than men at enrollment. 