Abstract: AIM To compare the effect of early and selective invasive strategy in high-risk patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS High-risk patients with NSTEMI in Xijing Hospital were divided into early intervention group and selective intervention group according to surgical time. Perioperative complications, in-hospital death, length of hospital stay and hospital costs were compared between groups. Patients were followed for 6 months and the occurrence of major adverse cardiovascular events (MACE) and the change of left ventricular ejection fraction (LVEF) were also compared between groups. RESULTS No statistically significant difference was found between groups according to rates of perioperative complications, in-hospital death and successful PCI, and MACE incidence. Length of hospital stay, hospital costs and the rate of hospital readmission due to recurrent angina and coronary heart disease in early intervention group were lower than those in selective intervention group. LVEF obviously increased in both groups and LVEF in early intervention group was higher than in the selective intervention group. CONCLUSION The short-term prognosis effect of early invasive strategy in high-risk patients with non-ST-elevation myocardial infarction is better than that of selective invasive strategy.