Abstract Background: To assess the extent of trans murality in non‑ST elevation myocardial infarction (NSTEMI) patients using speckle‑tracking echocardiography (STE) in relation to their risk categorization to improve the risk stratification of NSTEMI patients through detecting the presence of transmural infarction. Patients and Methods: It included 96 patients with NSTEMI. All patients were subjected to GRACE score (GS) calculation, transthoracic and speckle-tracking echocardiography (STE): To detect left ventricular ejection fraction and myocardial global longitudinal strain [GLS]and circumferential strain [CS]. Results: As compared to low‑GS group; high‑risk group was older with the increased prevalence of hypertension (HTN), diabetes, and smoking. There was no significant difference between both groups regarding LS and CS of all 17 segments except for apex where longitudinal strain (LS) was significantly decreased in low‑risk group (−17.2 ± 1.1) as compared to high‑risk group (−18.6 ± 1.4). GLS was significantly decreased in high‑risk group (15.4 ± 0.6) as compared to low‑risk group (16 ± 0.8), P = 0.02 with no significant difference in the global CS (P = 0.8). Transmural infarction constitutes 37.5% of all patients. The prevalence of transmural infarction was increased in the low‑risk group without significant difference. GS showed a positive correlation with age, male, HTN, diabetes, and smoking and negative correlation with GLS. There was no significant correlation between GS and global CS. Age, GS, and LS were significantly related to transmural infarction. None was found to predict the occurrence of transmural infarction. Conclusion: Transmural extent as detected by STE had been found in a relatively substantial number of patients with NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high‑risk patients. Keywords: GRACE score, non‑ST elevation myocardial infarction, speckle‑tracking echocardiography, transmural extent.