Title
Management of Chronic Coronary Syndromes
Authoring Organization
Publication Month/Year
August 30, 2024
Last Updated Month/Year
September 3, 2024
Document Type
Guideline
Country of Publication
European
Document Objectives
The current guidelines for managing chronic coronary syndromes (CCS) are intended to assist in diagnosing and initiating treatment for individuals with suspected CCS, as well as in the long-term management of patients with confirmed CCS. These guidelines recommend using a risk factor-weighted clinical likelihood model to estimate the most up-to-date clinical likelihood of obstructive coronary artery disease (CAD). Compared to the basic 2019 ESC pre-test probability model, incorporating risk factors into the pre-test likelihood model (which considers age, sex, and symptoms) enhances the prediction of obstructive CAD. This approach reclassifies more individuals into the very low and low likelihood categories, where further testing may be unnecessary. An updated diagnostic algorithm is provided for patients with moderate or high pre-test likelihood. The Guidelines also include an expanded section on diagnosing and treating patients with angina and no or nonobstructive coronary artery disease, now termed ANOCA-INOCA. The treatment section offers guidance on anti-anginal/anti-ischemic medications and various event-preventing therapies. It also covers strategies to improve adherence to medical treatment and prescribed lifestyle changes. Additionally, the guidelines review indications for and selection of the optimal revascularization modality based on findings from large RCTs and IPDAs. Lastly, options for managing recurrent or refractory angina/ischemia are discussed.
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D003327 - Coronary Disease
Keywords
chronic coronary disease, chronic coronary syndromes
Source Citation
Christiaan Vrints, Felicita Andreotti, Konstantinos C Koskinas, Xavier Rossello, Marianna Adamo, James Ainslie, Adrian Paul Banning, Andrzej Budaj, Ronny R Buechel, Giovanni Alfonso Chiariello, Alaide Chieffo, Ruxandra Maria Christodorescu, Christi Deaton, Torsten Doenst, Hywel W Jones, Vijay Kunadian, Julinda Mehilli, Milan Milojevic, Jan J Piek, Francesca Pugliese, Andrea Rubboli, Anne Grete Semb, Roxy Senior, Jurrien M ten Berg, Eric Van Belle, Emeline M Van Craenenbroeck, Rafael Vidal-Perez, Simon Winther, ESC Scientific Document Group , 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), European Heart Journal, 2024;, ehae177, https://doi.org/10.1093/eurheartj/ehae177