Selection of Initial Treatment Strategy: Invasive Versus Conservative Strategy2
| Strategy | Status | Patient Characteristic |
|---|---|---|
| Invasive | Generally preferred | Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy |
| Elevated cardiac biomarkers (TnT or TnI) | ||
| New or presumably new ST-segment depression | ||
| Signs or symptoms of HF or new or worsening mitral regurgitation | ||
| High-risk findings from noninvasive testing | ||
| Hemodynamic instability | ||
| Sustained ventricular tachycardia | ||
| PCI within 6 mo | ||
| Prior CABG | ||
| High-risk score (eg, TIMI, GRACE) | ||
| Mild to moderate renal dysfunction | ||
| Diabetes mellitus | ||
| Reduced left ventricular function (LVEF <40%) | ||
| Conservative | Generally preferred | Low-risk score (eg, TIMI, GRACE) |
| Patient or physician preference in the absence of high-risk features |
CABG indicates coronary artery bypass graft; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; TIMI, Thrombolysis in Myocardial Infarction; TnI, troponin I; and TnT, troponin T. Reprinted from Anderson et al.2