ASA indicates aspirin; CABG, coronary artery bypass graft; cath, catheter; COR, Class of Recommendation; DAPT, dual antiplatelet therapy; GPI, glycoprotein IIb/IIIa inhibitor; LOE, Level of Evidence; NSTE-ACS, non ST-elevation acute coronary syndrome; PCI, percutaneous coronary intervention; pts, patients; and UFH, unfractionated heparin. NSTE-ACS (without serious comorbidities or contra- indications to this approach) who have an elevated risk for clinical events.333,334,338 (Level of Evidence: B) 2. The decision to implement an ischemia-guided strat- egy in initially stabilized patients (without serious comorbidities or contraindications to this approach) may be reasonable after considering clinician and patient preference. (Level of Evidence: C) Class III: No Benefit 1. An early invasive strategy (ie, diagnostic angiogra- phy with intent to perform revascularization) is not recommended in patients with: a. Extensive comorbidities (eg, hepatic, renal, pulmo- nary failure; cancer), in whom the risks of revascular- ization and comorbid conditions are likely to outweigh thebenefitsofrevascularization.(LevelofEvidence:C) b. Acute chest pain and a low likelihood of ACS who are troponin-negative (Level of Evidence: C), espe- (Level of Evidence: B) have con- cluded that a strategy of routine invasive therapy is generally superior to an ischemia-guided strategy or selectively invasive approach. One study reported that the routine invasive strategy resulted in an 18% relative reduction in death or MI, including a significant reduction in MI alone.341 The routine invasive arm was associated with higher in-hospital mortality (1.8% versus 1.1%), but this disadvantage was more than compensated for by a significant reduction in mortality between discharge and the end of follow-up (3.8% versus 4.9%). The invasive strategy was also associated with less angina and fewer rehospitalizations. Patientsundergoingroutineinvasivetreatmentalsohadimproved quality of life. 