Invasive Coronary Angiography Early in Ischemic Heart Failure

Inclusion Criteria: Adult patients with acute heart failure, hospitalized in Ontario, Canada, with evidence of possible ischemic heart disease, defined as at least one of: a) prior myocardial infarction, b) troponin elevation, or c) angina. Exclusion Criteria: * Recent myocardial infarction * Coronary angiogram or revascularization within previous 3 months before admission * Nonresidents of Ontario, invalid health card number * HF diagnosed after admission * Admission BNP or NT-proBNP not diagnostic of HF * Died within 14 days of admission * Palliative within 6 months prior to hospital admission * Elevated creatinine concentration * Documented anaphylactic contrast allergy * Ischemic or hemorrhagic stroke within 3 months prior to admission * Highest category of Hospital Frailty Risk Score * Active severe bleeding at time of hospital admission * Absolute platelet count \< 20 * Metastatic cancer