Research on the use of optical coherence tomography (OCT) in acute coronary syndrome (ACS) has increased in recent years. However, a comprehensive analysis of the trends and hotspots in OCT research is currently lacking. The objective of this study was to identify global trends in research on OCT in ACS from a bibliometric perspective and to provide researchers with new research hotspots. Relevant literature from 1998 to 2023 was retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to collect and analyze publication trends in related fields. A total of 965 publications from 58 countries and 1389 institutions were included in the present study. We found that Japan produced the most publications (20.83%, 201), followed by the United States (19.90%, 192), and China (14.09%, 136). However, the United States has the highest total number of citations in this field. Harvard Medical School and Harbin Medical University had the highest numbers of publications and citations. The journal with the most publications was the International Journal of Cardiology. Plaque erosion, calcified nodules, and intracoronary imaging are the most recent research hotspots and frontiers. Our work summarizes 25 years of OCT research in the ACS, highlighting hotspots, key themes, and emerging frontiers to help guide future research.