Are you up to speed on the latest changes in acute coronary syndrome (ACS) management? Initial Evaluation and Prehospital CareRapid ECG: All suspected ACS patients should receive an ECG within 10 minutes of arrival. ICU Admission: All unstable ACS patients should be admitted to the ICU for close monitoring and rapid intervention if needed. ConclusionThe 2025 ACC/AHA ACS guideline brings important perioperative updates—especially in initial triage, oxygen use, anticoagulation, and DAPT management. All ACS patients should receive aspirin and a P2Y12 inhibitor; duration of DAPT is tailored to bleeding risk and comorbidities.