[Chronic coronary syndrome]

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.