The meta-analysis did not show any significant differ- ences with regard to all-cause mortality (RR: 0.76; 95% CI: 0.49 P 0.22), and the composite of death/nonfatal MI (RR: 0.79; Our recommendation is that an early invasive strategy (ie, diagnostic angiography with intent to perform revasculariza- tion) is a reasonable strategy in patients with mild and moderate CKD. Clinicians should exercise judgment in all populations with impaired kidney function when considering whether to implement an invasive strategy. Such implemen- tation should be considered only after careful assessment of the risks, benefits, and alternatives for each individual patient. The observational data with regard to patients with mild to severe CKD also support the recognition that CKD is an underappreciated high-risk characteristic in the UA/NSTEMI population. The increased risk of mortality associated with mild, moderate, and severe CKD remains evident across stud- ies.162,163,168,193 Indeed, the risks of short- and long-term mortal- ity are increased as the gradient of renal dysfunction wors- ens.162,168,193 The optimal role of early revascularization in this heterogeneous population of patients remains an important topic of research and investigation as discussed earlier in this update. 7. Conclusions and Future Directions 7.1. Quality of Care and Outcomes for UA/NSTEMI: Recommendation (See Table 9.) 7.1.1. 