Inflammation plays a pivotal role in the pathogenesis of atherosclerosis and its complications. In particular, atherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS). Accumulating data demonstrate that in ACS, elevated levels of circulating inflammatory markers, such as C-reactive protein, predict an unfavorable cardiovascular outcome. A better knowledge of the molecular and cellular mechanisms of inflammation might not only further improve prognostic stratification but also allow us to identify novel therapeutic targets. The present review summarizes the mechanisms of the inflammatory response in ACS, its clinical implications, and the potential treatment strategies to contrast this phenomenon.