Use of Performance Measures and Registries: Recommendation Class IIa 1. Participation in a standardized quality-of-care data registry designed to track and measure outcomes, complications, and performance measures can be beneficial in improving the quality of NSTE-ACS (Level of Evidence: B) The development of national systems for ACS is crucial and includes the participation of key stakeholders to evaluate care using standardized performance and quality-improvement measures for ACS.819,821 Standardized quality-of-care data reg- istries include the NCDR Registry Get With the Guidelines, the Get With the Guidelines quality-improvement program, the Acute Myocardial Infarction Core Measure Set, and performance measures required by The Joint Commission and the Centers for Medicare and Medicaid Services.817,823 825 The AHA has promoted its Mission: Lifeline initiative to encourage cooperation among prehospital emergency medi- cal services personnel and cardiac care professionals.817 The evaluation of ACS care delivery across traditional boundar- ies can identify problems with systems and enable application of modern quality-improvement methods.818,820,822 On a local level, registries as part of the Chronic Care Model were asso- ciated with improved outcomes in chronic diseases, including 9. Summary and Evidence Gaps Despite landmark advances in the care of patients with NSTE- ACS since the publication of the 2007 UA/NSTEMI CPG,212 many emerging diagnostic and therapeutic strategies have posed new challenges. There is general acceptance of an early invasive strategy for patients with NSTE-ACS in whom sig- nificant coronary vascular obstruction has been precisely quantified. Low-risk patients with NSTE-ACS are documented to benefit substantially from GDMT, but this is often subopti- mally used. Advances in noninvasive testing have the potential to identify patients with NSTE-ACS who are at intermediate risk and are candidates for invasive versus medical therapy. Newer, more potent antiplatelet agents in addition to antico- agulant therapy are indicated irrespective of initial treatment strategy. 