Numerator Patients with acute NSTEMI who are high risk* and receive early invasive strategy (diagnostic angiography with intent to perform revascularization if appropriate based on coronary anatomy) within 24 h of admission *A high-risk NSTEMI patient is best defined by an objective risk score (eg, GRACE risk score >140 or TIMI risk score >4). Denominator All patients with acute NSTEMI who are at high risk Denominator Exclusions Patients age <18 y Patients who leave against medical advice on day of or day after arrival Patients who die early during hospitalization on day of or day after arrival Patients who are on comfort care measures only or hospice on day of or day after arrival Patients who are transferred to another hospital for inpatient care on day of or day after arrival Patients discharged on day of or day after arrival Patients received in transfer from the inpatient, outpatient, or ED of another facility Patients who are unstable (refractory angina/ischemia, new or worsening heart failure, mitral regurgitation, hemodynamic instability, sustained ventricular fibrillation or pulseless ventricular tachycardia), need urgent/immediate invasive strategy within 2 h, and are excluded from denominator and numerator Denominator Exceptions Documentation of a medical reason for not receiving an early invasive strategy after high-risk NSTEMI (eg, extensive clinical comorbidities, contraindications to invasive angiography, terminal illness/futile) Documentation of a patient reason for not receiving an early invasive strategy after high-risk NSTEMI Documentation of a system reason for not receiving an early invasive strategy after high-risk NSTEMI (eg, financial barriers, hospitalization at a facility without a cardiac catheterization laboratory) Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale have concluded that a strategy of routine invasive therapy is generally superior to an ischemia-guided strategy or a selectively invasive approach. 