In this interview with Professor Borja Ibáñez (National Centre for Cardiovascular Research CNIC and Fundacion Jimenez Diaz Hospital, Madrid, Spain), one of the Task Force co-ordinators of the ESC 2023 Guidelines for the management of acute coronary sydromes, and Dr Riccardo Asteggiano (LARC [Laboratorio Analisi Ricerca Clinica], Turin, Italy) underline the complex aspects of long-term therapy after ACS, mainly concerning antithrombotic management and secondary prevention management.