Non-ST-segment elevation acute coronary syndromes (NSTE-ACS), encompassing non-STsegment elevation myocardial infarction (NSTEMI) and unstable angina (UA), lack the declarative electrocardiographic findings that readily identify patients with ST-elevation myocardial infarction (STEMI) yet comprise >70% of all ACS1–3. Unlike STEMI patients who receive uniform treatment to restore flow in an occluded artery, NSTE-ACS patients (who often present first to an emergency department) have varying degrees of coronary obstruction, undergo more heterogeneous management and have worse long-term outcomes2, 4. Despite guidelines, there remains inconsistent utilization of routinelyadvocated medical therapies and invasive evaluation5 that reflect uncertainty in initial evaluation. Greater age and comorbidities plus varied coronary artery disease (CAD) severity further complicate decision-making. And while cardiogenic shock, heart failure and arrhythmias may be less than in STEMI, NSTE-ACS patients suffer more recurrent events and worse long-term outcomes1.