Non ST Elevation Acute Coronary Syndromes have a higher cumulative mortality than STEMI and are a growing challenge to cardiologists. The question of whether invasive angiography is required in this group has been supplanted by how long any delay should be. The data from the GRACE registry demonstrate a risk averse behaviour amongst cardiologists which translates into worse outcomes for those not receiving an early invasive strategy (<72hrs of presentation) as recommended by the European Society of Cardiology. Together with the results from recent randomised controlled trials, these data suggest that a radically different clinical approach to the management of patients with this condition is needed.
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