Background. Multivessel disease (MVD) is noted in about half of patients with NSTE-ACS It is associated with worse outcome. Objectives. In the current study, we compared multivessel PCI versus culprit-only PCI in patients presented with NSTE-ACS who have MVD. Methods. This prospective, controlled study included 50 consecutive patients with NSTE-ACS. All patients had multi-vessel CAD with ≥ 70% diameter stenosis estimated visually or using quantitative coronary angiography (QCA) on coronary angiography. 50% of patients undergone culprit only PCI, while 50% had total revascularization. Thirty days adverse cardiovascular events were reported in both groups. Results. No mortality was reported in either group. Re-hospitalization due to ACS was reported in 16% of patients (20% versus 12% in culprit only and total revascularization patients respectively, p=0.15). Target or new target revascularization was reported in 6% (12% versus 0% in culprit only and total revascularization patients respectively, p=0.03), Re-infarction was reported in 4% of all patients, all of them were from culprit only PCI patients, p=0,14 . Conclusion. Total revascularization PCI is feasible, efficient and safe compared with culprit vessel PCI in patients with MVD presenting with NSTE-ACS.