Brahmajee K. Nallamothu, MD, MPH, is assistant professor of internal medicine, Cardiovascular Center, University of Michigan, Ann Arbor, MI.

Treatment of stable patients with acute coronary syndrome (ACS) is controversial. Until recently, large randomized clinical trials had indicated that an "early" invasive strategy with routine cardiac catheterization reduced the likelihood of recurrent cardiovascular events when compared with a more "selective" approach, in which stable patients were referred to cardiac catheterization based on high-risk features on noninvasive stress imaging or because of a failure in initial medical therapy.