Despite significant goals achieved in diagnosis and treatment in recent decades, coronary artery disease (CAD) remains a high mortality entity and continues to pose substantial challenges to healthcare systems globally. After the latest guidelines, novel data have emerged and have not been yet considered for routine practice. The scope of this review is to go beyond the guidelines, providing insights into the most recent clinical updates in CAD, focusing on non-invasive diagnostic techniques, risk stratification, medical management and interventional therapies in the acute and stable scenarios. Highlighting and synthesizing the latest developments in these areas, this review aims to contribute to the understanding and management of CAD helping healthcare providers worldwide.

The classical concept of plaque vulnerability, centred on specific morphological features, has failed to deliver reliable risk prediction in clinical practice. Recent evidence highlights the need to redefine coronary vulnerability as a dynamic, patient-specific phenotype shaped by plaque biology, systemic inflammation, and haemodynamic forces. Advanced imaging modalities, artificial intelligence, and circulating biomarkers now enable a multidimensional assessment of this complex phenotype. This integrative approach may offer a more precise framework for risk stratification and personalised prevention in coronary artery disease.