TABLE 10-5 - Indications for catheterization and percutaneous coronary intervention.

Acute coronary syndromes (unstable angina and non-ST elevation MI)
Class I	Early invasive strategy for any of the following high-risk indicators: Recurrent angina/ischemia at rest or with low-level activity Elevated troponin ST segment depression Recurrent ischemia with evidence of CHF High-risk stress test result EF < 0.40 Hemodynamic instability Sustained ventricular tachycardia PCI within 6 months Prior CABG In the absence of these findings, either an early conservative or early invasive strategy
Class IIa	Early invasive strategy for patients with repeated presentations for ACS despite therapy
Class III	Extensive comorbidities in patients in whom benefits of revascularization are not likely to outweigh the risks Acute chest pain with low likelihood of ACS
Acute MI after fibrinolytic therapy (2004 ACC/AHA AMI Guideline)
Class I	Recurrent ischemia (spontaneous or provoked) Recurrent MI Cardiogenic shock or hemodynamic instability
Class IIa	LVEF = 0.40, CHF (even transient), serious ventricular arrhythmias
Class IIb	Routine PCI as part of invasive strategy after fibrinolytic therapy

Key: MI = myocardial infarction; CHF = congestive heart failure; EF = ejection fraction; PCI = percutaneous coronary intervention; CABG = coronary artery bypass grafting; ACS = acute coronary syndrome; ACC/AHA = American College of Cardiology/American Heart Association; AMI = acute myocardial infarction; LVEF = left ventricular ejection fraction.