Revascularization in an acute coronary syndrome without ST-segment elevation (ACS-NSTE) relieves symptoms of ischaemia, shortens hospitalization time and improves prognosis in medium and high risk patients with GRACE score over 110. Coronary intervention should be during the index hospitalization according to the risk score in horizon of 2, 24 or up to 72 hours. The share of NSTEMI vs acute myocardial infarctions with ST-segment elevation is increasing. The share of early invasively examined patients is growing in the Slovak republic. In 2011 two thirds of patients with NSTEMI were examined by coronarography in the acute phase of the disease. Percutaneous coronary intervention (PCI) is in the treatment of acute coronary syndromes (ACS) a dominant revascularisation method. It has to be supported by ACS pharmacotherapy. It is related to certain specifics. Some of them are stated in this review, where we point out to advantages and disadvantages of transfemoral and transradial approach and solutions for ACS characteristic intracoronary thrombosis. Onward we are mentioning advantages and disadvantages of drug eluting stents DES and classical stents (BMS) in ACS and the importance to achieve complete revascularization and solutions for haemodynamically unstable patients. We point out to the acute ramus circumflex occlusion and its manifestation as a NSTEMI and not as STEMI. We are also briefly presenting decision making which leads to indication of coronary bypass (CABG) or PCI in multilevel coronary diseases. At the end we are stating drawbacks in NSTEMI patient management with the aim to improve stratification and implementation of the guidelines of the European Society of Cardiology.