In non ST-elevation myocardial infarction (NSTEMI), the global registry of acute coronary events (GRACE) score predict cardiovascular events. However, it is unknown how global longitudinal peak systolic strain compares with GRACE and how their combination performs in NSTEMI. Methods: The study population consisted of 117 consecutive patients with first NSTEMI. We measured admission GRACE score and performed speckle tracking echocardiography at initial presentation before coronary intervention. The global longitudinal peak systolic strain average (GLPSS Avg) was obtained by automated function imaging (AFI). Subsequent complications including cardiac death, shock, re-infarction, congestive heart failure after onset of NSTEMI were prospectively evaluated during 6 months. Results: Cardiovascular events were developed in 25 patients at 6 months. In cardiovascular events group showed higher GRACE score (168 짹 50 vs 121 짹 38) and higher GLPSS Avg (-11.5 짹 4.5 vs -15.2 짹 3.3). Both higher GRACE score and higher GLPSS Avg predicted cardiovascular events. There was a significant but only partial correlation between the GRACE score and GLPSS Avg (R = 0.566, P <0.001). Patients with both high GRACE score and GLPSS Avg were more likely to experience cardiovascular events at 6 months by Kaplan-Meier analysis [RR 6.41 (95% CI, 2.11 - 19.90)] (Figure). Conclusion: The combined use of both the GRACE score and GLPSS Avg can identify a subset of NSTEMI patients at particularly high risk. This implies that both the GRACE score and GLPSS Avg reflect somewhat different risk attributes when predicting adverse prognosis in NSTEMI and their synergistic use can enhance risk stratification in NSTEMI to a small but potentially useful extent.