Advances in the Diagnosis and Management of Acute Coronary Syndrome: A Clinical Review

Acute coronary syndrome (ACS) encompasses a spectrum of ischemic cardiac conditions associated with significant global morbidity and mortality, commonly driven by atherosclerotic plaque disruption and thrombosis, and remains a major clinical challenge despite advances in cardiovascular care. Persistent variability in early diagnosis, risk stratification, and the integration of emerging therapies into routine practice highlights existing gaps in translating evolving evidence into consistently improved clinical outcomes. This narrative clinical review aims to synthesise recent advances in diagnostic approaches and therapeutic strategies, focusing on biomarkers, imaging modalities, pharmacological interventions, and precision-based management. A structured narrative literature search was conducted using PubMed and Google Scholar for English-language human studies published between 2015 and 2025. Search terms included "acute coronary syndrome," "high-sensitivity troponin," "biomarkers," "coronary computed tomography angiography," "intravascular ultrasound," "optical coherence tomography," "antiplatelet therapy," "anticoagulation," "lipid-lowering therapy," and "precision medicine." Guidelines, randomised trials, systematic reviews, meta-analyses, and high-impact reviews were included, while duplicate, non-English, non-coronary, and clinically irrelevant studies were excluded. Study relevance and quality were narratively assessed using the Scale for the Assessment of Narrative Review Articles (SANRA) principles, with emphasis on justification of the manuscript's importance, clarity of review aims, appropriateness of the literature search, balanced evidence presentation, scientific reasoning, and clinical relevance of the synthesis. Findings indicate that high-sensitivity troponins, advanced imaging techniques, and contemporary antithrombotic and lipid-lowering therapies have enhanced diagnostic accuracy and improved clinical outcomes. Emerging anti-inflammatory therapies and digital health innovations further contribute to more individualised patient management. These developments support the integration of novel tools with established clinical pathways to optimise care delivery. Continued research and improved implementation strategies remain necessary to address disparities and refine management approaches. A multidimensional, patient-centred framework is essential for advancing outcomes and guiding future clinical practice in ACS.