Advances in cancer treatment have improved the survival of cancer patients, leading to a higher incidence of cardiovascular events. Acute coronary syndrome is the most serious and life-threatening condition among them. Its incidence in cancer patients is higher than in the general population. The cause is common cardiovascular risk factors, prothrombotic and inflammatory effects of malignancy. Contributing to this is the vascular toxicity of several current oncology treatments. Its burden is expected to increase further in connection with the aging of the population and the improvement of the survival of cancer patients. The article highlights the transition from risk assessment to personalized clinical decision making.