What are the two pathways for patients with NSTE-ACS? 
Two treatment pathways have emerged for all patients with NSTE-ACS. The invasive strategy triages patients to an invasive diagnostic evaluation (ie, coronary angiography). In contrast, the initial ischemia-guided strategy calls for an invasive evaluation for those patients who 1) fail medical therapy (refractory angina or angina at rest or with minimal activity despite vigorous medical therapy), 2) have objective evidence of ischemia (dynamic electrocardiographic changes, myocardial perfusion defect) as identified on a noninvasive stress test, or 3) have clinical indicators of very high prognostic risk (eg, high TIMI or GRACE scores).