How do you approach the decision of when to perform left heart catheterization in a patient with an NSTEMI who recently had an acute ischemic stroke?

This is a complicated question. Most acute CVA patients have non-MI troponin elevations, and I generally treat them medically. If there is a true NSTEMI associated with CVA, it requires a thoughtful approach. I generally divide my NSTEMI patients into high-risk and non-high-risk.

I will perform a diagnostic angiogram in a high-risk patient and may perform PCI if truly necessary (Also involve the neurology regarding these decisions). I will treat non-high-risk patients medically and bring them back for outpatient cardiac catheterization in a few weeks.