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Introduction: It is estimated that in the United States, each year, >780,000 persons will experience an acute coronary syndrome (ACS). Approximately 70% of these will have non ST elevation-myocardial infarction (NSTEMI). Optimal timing of angiography in NSTEMI is matter of debate. Hypothesis: The aim of this retrospective analysis was to evaluate the 1 year major cardiovascular events (MACE) in patients presenting with NSTEMI and undergoing percutaneous intervention (PCI) Methods: Within our PCI database we identified 1550 patients who underwent PCI for NSTEMI. We then divided the population into 3 groups based on door to balloon time (D2BT) (group 1= D2BT<90 min; group 2 = D2BT >90 min <24h; group 3 = D2BT >24 h). Primary outcome was MACE/target vessel revascularization (TVR) (composite of MI, death and TVR) at 1 year Results: Characteristics of the patient population is reported in the table. Patients with D2BT<90 min were more likely to present with cardiogenic shock and had higher baseline and peak troponin level, indicating a significant bias related to the operator choice. In-hospital, 6 months and 1 year outcomes are reported in the figure. Overall the group with D2BT>90 min and <24h had better outcomes. Conclusions: In this large cohort of patients presenting with NSTEMI, patients undergoing PCI between 90 min to 24 h from presentation had better 1 year outcomes. However, treatment selection bias makes causal inference concerning rapid revascularization and outcome unreliable. Randomized clinical trials are warranted to assess outcome of rapid revascularization in patients presenting with NSTEMI [ABSTRACT FROM AUTHOR]