In patients with symptoms of ischaemic heart disease, despite optimal medical therapy, a PCI or CABG may be indicated if the coronary arteries are narrowed. Decisions regarding PCI or CABG need to be taken by the local heart team, consisting of a cardiothoracic surgeon and an interventional cardiologist. After a complete diagnostic work-up, the referring cardiologist presents the patient with accompanying written information supporting revascularisation. The decision of the heart team takes the characteristics of each individual patient into account and, most importantly, the coronary angiogram. Despite improvements in medical and interventional treatments, mortality and morbidity remain high among patients with NSTEMI. Early risk stratification is essential to determine those patients who can be treated safely with medical therapy and those who require interventional treatment. Ad hoc PCI is indicated in patients with STEMI or haemodynamic instability.