Among patients in the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS)-Thrombolysis In Myocardial Infarction (TIMI) 18 study, decreasing renal function was associated with an increased prevalence of high-risk clinical findings, more extensive coronary artery disease, and independently associated with a high rate of adverse ischemic events after non-ST-segment elevation acute coronary syndrome (NSTE ACS). Across the range of renal function among patients in TACTICS-TIMI 18, the use of tirofiban plus an early invasive strategy was superior to conservative, ischemia-guided NSTE ACS management.