{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:04Z","timestamp":1787028664021,"version":"build-2736575974"},"reference-count":109,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC\/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: This state-of-the-art review synthesizes advances from 2023 to 2025 across five domains. Diagnosis: High-sensitivity troponin-based accelerated pathways remain foundational; GRACE 3.0 improves calibration for early vs. delayed angiography, while selective use of CCTA and routine use of intracoronary imaging\/physiology help define the mechanism and optimize PCI. Revascularization: complete revascularization continues to underpin care in multivessel disease, with recent data favouring culprit-only PCI acutely and staged non-culprit treatment during the index stay in most STEMI presentations, particularly with heart-failure physiology. Antithrombotic therapy: Aspirin remains critical early after ACS-PCI; emerging evidence supports shorter DAPT and aspirin withdrawal after 1 month in carefully selected, low-ischaemic-risk patients, whereas day-0 aspirin-free strategies in unselected ACS are not non-inferior. Secondary prevention: A \u201cstrike early and strong\u201d approach to LDL-cholesterol\u2014often with combination therapy in hospital\u2014is emphasized, alongside nuanced roles for SGLT2 inhibitors and GLP-1 receptor agonists. Special populations and implementation: Sex- and age-aware tailoring (including MINOCA\/SCAD evaluation), pragmatic bleeding-risk mitigation, digitally enabled cardiac rehabilitation, and registry-driven quality improvement translate evidence into practice. Summary: Contemporary ACS care is moving from uniform protocols toward risk-stratified, mechanism-informed pathways. We offer practical algorithms and checklists to align interventional timing, antithrombotic intensity\/duration, and secondary prevention with individual patient risk\u2014bridging new evidence to bedside decisions.<\/jats:p>","DOI":"10.3390\/jcm15010016","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T12:59:57Z","timestamp":1766149197000},"page":"16","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acute Coronary Syndromes: State-of-the-Art Diagnosis, Management, and Secondary Prevention"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6466","authenticated-orcid":false,"given":"Xun","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Trust Foundation, London SW3 6NP, UK"},{"name":"Department of Cardiology, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5779-7549","authenticated-orcid":false,"given":"Stephan","family":"Nienaber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Centre Cologne, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-6147","authenticated-orcid":false,"given":"Ibrahim","family":"Akin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Heidelberg-Campus Mannheim, 69120 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tito","family":"Kabir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Trust Foundation, London SW3 6NP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph A.","family":"Nienaber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Trust Foundation, London SW3 6NP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025, December 15). 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