question: In the field of ischemic heart disease 2020 was an exciting year. The coronavirus disease 2019 (COVID-19) pandemic had a major impact on the diagnostics and treatment of coronary heart disease in many ways. In addition, the results of the ISCHEMIA study have at least in part questioned the previous practice of the treatment of stable chronic coronary syndrome (CCS). In this study, myocardial revascularization was not associated with improvement in the prognosis of patients with stable ischemia but resulted in an improvement in the quality of life and angina pectoris symptoms compared to optimal medical therapy. In the field of acute coronary syndromes (ACS), publications from 2020 enhanced the concepts of the new European guidelines on non-ST-segment elevation ACS (NSTE-ACS). For the first time, the benefit of early invasive treatment in NSTE-ACS could be demonstrated for patients ≥ 80 years of age. Recent analyses also confirmed the concept of complete revascularization for multivessel disease in ST-segment elevation myocardial infarction without shock. This concept is now being applied to NSTE-ACS. In antiplatelet therapy, recent studies challenged antiplatelet pretreatment as part of the early invasive strategy with unknown coronary artery status. Several studies showed the potential benefit of de-escalation of antiplatelet therapy after NSTE-ACS, especially in older patients.