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Managing chronic coronary syndrome: how do we achieve optimal patient outcomes?

Antonis A Manolis1, Theodora A Manolis2, Antonis S Manolis3

  • 1Department of Medicine, Elpis General Hospital, Athens, Greece.

Expert Review of Cardiovascular Therapy
|May 17, 2024
PubMed

Insights

Chronic coronary syndrome (CCS) is a major cause of death. This review covers CCS phenotypes, diagnostic methods like CCTA and CAC scoring, and multidisciplinary management including new therapies and cardiac rehabilitation.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine

Background:

  • Chronic coronary syndrome (CCS) is a leading global cause of mortality and high hospitalization rates.
  • Understanding CCS phenotypes is crucial for effective patient management.

Purpose of the Study:

  • To review current diagnostic modalities for CCS, including noninvasive and invasive testing.
  • To discuss multidisciplinary management strategies and emerging therapeutic options for CCS.
  • To highlight the role of cardiac rehabilitation and advanced treatments for refractory symptoms.

Main Methods:

  • Literature search of medical databases for CCS and its management.
  • Review of diagnostic techniques: stress-echocardiography, coronary computed-tomography angiography (CCTA), coronary artery calcium (CAC) scoring, echocardiography, and biomarkers.
  • Analysis of multidisciplinary management approaches, including risk factor modification, pharmacotherapies, and revascularization.
  • Evaluation of newer treatments (colchicine, ivabradine, ranolazine, melatonin), cardiac rehabilitation, implantable defibrillators (ICD), and extracorporeal shockwave-revascularization.

Main Results:

  • Stress-echocardiography defines CCS phenotypes.
  • CAC scoring and CCTA are key for assessing atherosclerosis burden and functional significance.
  • Multidisciplinary CCS management involves risk factor control, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization.
  • Emerging therapies and cardiac rehabilitation improve outcomes and quality of life.

Conclusions:

  • Effective CCS management requires a multidisciplinary approach integrating advanced diagnostics and tailored therapies.
  • Newer pharmacological agents and lifestyle interventions like cardiac rehabilitation are vital for improving patient prognosis and quality of life.
  • Advanced treatments offer options for refractory CCS symptoms and sudden cardiac death prevention.
Abstract

Keywords:
Chronic coronary syndromechronic ischemiacoronary angiographycoronary artery calciumcoronary artery diseasecoronary computed tomography angiographycoronary revascularizationechocardiography

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