The conclusions drawn from the introductory story are basically inaccurate. Acute coronary syndrome (for which catheterization is indicated) comes in three flav

The conclusions drawn from the introductory story are basically inaccurate. Acute coronary syndrome (for which catheterization is indicated) comes in three flavors: STEMI, NSTEMI, and unstable angina. STEMI is the type of heart attack that has EKG changes. NSTEMI is heart attack without (criteria-meeting) EKG changes. The definition of unstable angina is chest pain at rest or new onset angina that limits activity. So, when the executive presented to the hospital, the doctors who proposed coronary angiography were following guidelines (and standard of care virtually everywhere in the United States). It is also true, however, that when the patient refused, left the hospital, fortunately had no events, and then presented as an outpatient to another doctor, it was reasonable at that point to forgo catheterization. Enough time had passed that his angina condition could be considered stable.