What is your approach to counseling an octogenarian on the risks and benefits of LHC in the context of NSTEMI complicated by new-onset heart failure and AKI on CKD? 

This is a complex though not uncommon clinical scenario to which my approach would depend on many factors beyond those provided in the vignette. Among these (not an exhaustive list and not necessarily in order of importance): Is this a type I or type II NSTEMI? Is there evidence of ongoing ischemia or hemodynamic instability? How severe are the CKD and AKI? What is the LV function? What are the patient’s baseline physical function and cognitive status? Is the patient frail? What are the patient’s preferences regarding the aggressiveness of care?

Depending on the response to these and other questions, my general approach would be to try to provide the patient and family with an individualized and unbiased appraisal of the potential benefits a...