LAUSR

T he cardiology community continues to debate the optimal management for patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS). Strategies include planned catheterization versus an ischemia-guided approach where the decision to perform catheterization is based on identification of high-risk characteristics ascertained from clinical observation and/or imaging studies. The argument to perform routine catheterization is to identify and revascularize the culprit lesion, which is usually a severe stenosis and not an occluded vessel. This strategy may prevent coronary artery occlusion and subsequent large myocardial infarction, as well as the deleterious effects of chronic myocardial ischemia, including left ventricular systolic/diastolic dysfunction, malignant arrhythmias, and unstable angina requiring hospitalization and revascularization. An ischemiaguided approach may be preferred to limit the risks of catheterization and revascularization including bleeding, periprocedural myocardial infarction, stent thrombosis, and in-stent restenosis (1).