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. The FRISC-II trial showed a benefit of revascu- larization in men for death or MI that was not observed for In contrast, death, MI, or rehospitalization rates were reduced for both men and women in TACTICS-TIMI RITA-3 showed that the routine strategy of invasive evaluation resulted in a beneficial effect in high-risk men that was not seen in women.342 A meta-analysis suggests that in NSTE-ACS, an invasive strategy has a comparable benefit in men and high-risk women for reducing the composite end- point of death, MI, or rehospitalization.141,345,346 In contrast, an ischemia-guided strategy is preferred in low-risk women.141 Another collaborative meta-analysis of randomized trials reported that an early invasive strategy yielded similar RR reductions in overall cardiovascular events in patients with and without diabetes mellitus.347 However, an invasive strat- egy appeared to reduce recurrent nonfatal MI to a greater extent in patients with diabetes mellitus. 4.4.6. Care Objectives Coronary angiography is designed to provide detailed infor- mation about the size and distribution of coronary vessels, the location and extent of atherosclerotic obstruction, and the suitability for revascularization. The LV angiogram, usually performed with coronary angiography, provides an assess- ment of the extent of focal and global LV dysfunction and of the presence and severity of coexisting disorders (eg, valvular or other associated lesions). Patients with NSTE-ACS can be divided into risk groups on the basis of their initial clinical presentation. 