In this interview with 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 Riccardo Asteggiano, Laboratorio Analisi Ricerca Clinica, Turin - Italy, underline the complex aspects of long-term therapy after ACS, mainly concerning antithrombotic management and secondary prevention management.