Objective:To determine the optimal strategy for the use of glycoprotein Ⅱb/Ⅲa(Gp Ⅱb/Ⅲa) inhibitors in patients with high-risk acute coronary syndromes(ACS) receiving an early invasive treatment. Methods:One hundred and sixty-two patients with high-risk ACS undergoing early percutaneous coronary syndromes were assigned to receive either routine upstream(n = 82) or deferred selective(n =80) Gp Ⅱb/Ⅲa inhibitor treatment. The authors evaluated the effects of two strategies on tissue-level perfusion using the TIMI myocardial perfusion grade(TMPG) before and immediately after PCI. Blooding complications and the 30 day composite end point events were also evaluated. Results:Among all the total 162 patients, the TMPG 0-1 perfusion were observed in 65 patients(40.1%). The TMPG 0-1 perfusion was significantly less frequent in routine upstream treatment(n = 27) than in deferred selective group(n = 38) before PCI(32.9% vs 47.5%, respectively; P < 0.05). No differences were seen both in 30 day composite end point events and bleeding complications. Conclusion:Among high-risk ACS patients treated with an early invasive strategy, routine upstream use of Gp Ⅱb/Ⅲa inhibitors is associated with tissue-level perfusion improved and without bleeding complications increased.