Advances in Diagnosis and Therapeutic Guidance for Acute Coronary Syndrome: A Narrative of A Precision Medicine Approach

Acute coronary syndrome (ACS) remains one of the leading causes of cardiovascular morbidity and mortality. Recent advances in high-sensitivity cardiac troponin assays, multimodal imaging, and antithrombotic therapies have introduced more individualized risk assessment and management. This review highlights a precision-oriented diagnostic pathway, which integrates the 0/1-hour algorithm with imaging modalities for the comprehensive evaluation of culprit and non-culprit lesions. Revascularization strategies are advancing, with imaging-guided percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), enabling more tailored approaches for complex diseases. Meanwhile, mechanical circulatory support offers potential benefits for cardiogenic shock; nevertheless, there are uncertainties regarding optimal timing and patient selection. Long-term antithrombotic therapy is becoming increasingly optimized. Recent strategies have focused on reducing the duration of dual antiplatelet therapy (DAPT) and exploring de-escalation approaches such as P2Y12 inhibitor monotherapy. Secondary prevention extends beyond lipid-lowering therapies and includes metabolic and anti-inflammatory interventions. Collectively, these advancements indicate a shift toward truly personalized care for ACS, aiming to improve outcomes by transitioning away from a one-size-fits-all approach.