Increasing attention is being given to assessing and improving the quality of care of patients presenting with acute coronary syndromes (ACS).1,2 In this issue of the Journal, Chew and colleagues report on the use and survival impact of early invasive management (coronary angiography and revascularisation) in 3393 patients with ACS enrolled in the Australian prospective ACACIA (Acute Coronary Syndrome Prospective Audit) registry.3 They used propensity-adjusted regression modelling to quantify effects of invasive care independently of other confounders such as patient characteristics, contraindications to invasive care and use of pharmacological treatments. While rates of invasive care appeared near to optimal (90%) in patients with ST-segment-elevation myocardial infarction (STEMI), rates were purported to be less optimal in those with non-STEMI (71%) and unstable angina (45%).