{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:25:48Z","timestamp":1786969548692,"version":"build-2736575974"},"reference-count":80,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet\u2013anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care.<\/jats:p>","DOI":"10.3390\/jcdd13080393","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:12:56Z","timestamp":1786713176000},"page":"393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contemporary Management of Acute Coronary Syndromes in the Cardiac Intensive Care Unit: From Rapid Diagnosis to Early Secondary Prevention"],"prefix":"10.3390","volume":"13","author":[{"given":"Domenico Mario","family":"Giamundo","sequence":"first","affiliation":[{"name":"Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5552-6382","authenticated-orcid":false,"given":"Giuseppe","family":"And\u00f2","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamas A.","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Department of Cardiology, Keele University, Newcastle ST5 5BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Pathak","sequence":"additional","affiliation":[{"name":"National Institute of Cardiology, Cardiovascular Surgery and Interventional Cardiology (INCCI), L-1210 Luxembourg City, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-942X","authenticated-orcid":false,"given":"Salvatore De","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2991-1548","authenticated-orcid":false,"given":"Stefano","family":"Figliozzi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirvat","family":"Alasnag","sequence":"additional","affiliation":[{"name":"Cardiac Center, King Fahd Armed Forces Hospital, Jeddah 9862, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Atar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Oslo University Hospital Ulleval, 0450 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-605X","authenticated-orcid":false,"given":"Elad","family":"Asher","sequence":"additional","affiliation":[{"name":"Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Sabouret","sequence":"additional","affiliation":[{"name":"ACTION Study Group, Inserm UMRS1166, Heart Institute, Piti\u00e9-Salpetriere Hospital, Sorbonne University, 47-83 Bd de L\u2019H\u00f4pital, 75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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