Acute coronary syndrome is a clinical condition caused by abrupt myocardial ischemia, and is a manifestation of coronary heart disease. It occurs as three different types, which are unstable angina pectoris, NSTEMI and STEMI. Development of ACS is associated with certain risk factors such as smoking, diabetes, hypertension, dyslipidemia and western lifestyles. Diagnostic and treatment of patients who present with symptoms indicative of ACS are often urgent , which proved to be quite a challenge during pandemic that affected healthcare systems throughout the world. New anti pandemic measures, fear of infection with unknown virus, and reluctance to burden the healthcare system have caused lower admittance rates of patients with ACS. COVID-19 virus has negative impact on cardiovascular patients due to it’s ability to cause miocarditis, microangiopathy, IM type 2, and cytokine storm. Societies of cardiology wrote new recommendations and guidelines for ACS treatment because the emerging challenges pandemic generated. Therapy of choice for STEMI, and high risk NSTEMI is still percutaneous coronary intervention, but with a recommendation of early intubation, before patients enters laboratory for catheterization since it lowers the risk of spreading infection.