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[Chronic coronary syndrome].

Stanislav Keranov1, Holger Nef1

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The European Society of Cardiology (ESC) updated guidelines rename stable coronary heart disease to chronic coronary syndrome (CCS). New diagnostic approaches improve pre-test probability assessment for stenosing coronary heart disease.

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Area of Science:

  • Cardiology
  • Clinical Guidelines

Background:

  • The European Society of Cardiology (ESC) introduced new guidelines in 2019.
  • Stable coronary heart disease was renamed chronic coronary syndrome (CCS).
  • CCS acknowledges the heterogeneity of the condition with six defined scenarios.

Purpose of the Study:

  • To outline the updated diagnostic and therapeutic recommendations for chronic coronary syndrome (CCS).
  • To highlight key changes in the assessment and management of patients with suspected or confirmed coronary heart disease.

Main Methods:

  • Review and synthesis of the 2019 ESC guidelines for CCS.
  • Emphasis on diagnostic assessment, including pre-test probability estimation.
  • Evaluation of updated recommendations for imaging and invasive procedures.

Main Results:

  • Introduction of dyspnea and refined clinical probability assessment for improved pre-test probability estimation.
  • Enhanced role for CT angiography in detecting coronary heart disease (CHD).
  • De-emphasis on routine exercise ECG for CHD detection; continued importance of invasive coronary angiography.

Conclusions:

  • The updated CCS guidelines offer a more nuanced approach to diagnosis and management.
  • Emphasis is placed on personalized risk assessment and the integration of lifestyle modification for prevention.
  • CT angiography is now a key imaging modality, while exercise ECG is less emphasized.