In this essential episode of Parallax, Dr Ankur Kalra is joined by Dr Michelle O'Donoghue, cardiologist at Brigham and Women's Hospital and co-author of the recently updated AHA/ACC acute coronary syndrome guidelines. Together, they explore the revolutionary changes reshaping ACS management in 2025. Dr O'Donoghue shares insights from the landmark guideline development process that unified non-ST elevation ACS and ST elevation MI recommendations into a single comprehensive document. The conversation covers game-changing updates including new risk stratification approaches, the shift toward selective invasive strategies, and the introduction of bivalirudin as an alternative anticoagulation option. The discussion highlights the groundbreaking "lower is better" approach to LDL management with new targets below 55 mg/dL, evolving antiplatelet therapy strategies, and the emerging role of ticagrelor monotherapy. Dr O'Donoghue also addresses future directions in cardiovascular care, from GLP-1 agonists to mechanical circulatory support devices, emphasizing how these guidelines represent a fundamental shift toward more personalized, evidence-based ACS management. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.