In 2004, the then National Institute for Clinical Excellence (NICE) published a technology-appraisal guideline on the treatment of patients with unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI). This article reports the results of a study in which triage and treatment for this patient group in one emergency department (ED) was assessed against this NICE guideline. The study found that patients were triaged by ED staff successfully but that there had been a lack of awareness of prognostic risk groupings and that compliance with guidelines on early antiplatelet therapy had not been ideal. The authors conclude, therefore, that the introduction of an ED pathway for patients with UA or NSTEMI would improve clinicians' compliance with the NICE guideline.