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The European Society of Cardiology 2024 Guidelines on Chronic Coronary Syndromes: A Critical Appraisal
Roberto Ferrari1,2, Luis Henrique W Gowdak3, Francisco Padilla4
1Department of Cardiology, University of Ferrara, 44121 Ferrara, Italy.
Insights
The European Society of Cardiology
Area of Science:
- Cardiology
- Clinical Guidelines
Background:
- New guidelines for chronic coronary syndromes (CCSs) were released by the European Society of Cardiology in 2024.
- These guidelines were published in the European Heart Journal.
Purpose of the Study:
- To summarize and comment on the 2024 European Society of Cardiology guidelines for chronic coronary syndromes (CCSs).
- To highlight the strengths and weaknesses of the new CCSs guidelines from an expert perspective.
Main Methods:
- Experts reviewed the 123-page chronic coronary syndromes (CCSs) guidelines document.
- Virtual discussions were held among experts to formulate comments on the guidelines.
Main Results:
- The guidelines are considered comprehensive, up-to-date, and a significant advancement in diagnosing and treating chronic coronary syndromes (CCSs).
- Key strengths include linking diagnosis and treatment to pathophysiology, adopting the "Diamond Approach" graphic, and innovative presentation with illustrations.
- A minor point of discussion was the full adoption of the "Diamond Approach" principle regarding antianginal drug superiority.
Conclusions:
- The reviewed guidelines represent a substantial improvement in chronic coronary syndromes (CCSs) management.
- The authors provide a balanced commentary on the strengths and potential areas for refinement within the new CCSs guidelines.
Abstract:
Background: During the 2024 annual meeting in London, The European Society of Cardiology released new guidelines (GLs) on chronic coronary syndromes (CCSs) and simultaneously published them in the European Heart Journal. Method: A few experts on the topic from Europe, South America, India, and Asia, who attended the presentation and the Question and Answer sections, met virtually to comment on the GLs after carefully reading the 123-page document. Result: There is a consensus that the presented GLs are a comprehensive, up-to-date, clear document of the available data on how to diagnose and treat CCSs and a definite step forward compared to all previous GLs. Of particular value are (a) the efforts to link both diagnosis and treatment to the underlying pathophysiology with the recognition that not all the ischaemic episodes are the same; (b) the decision to adopt the graphic of the so-called "Diamond Approach", although its spirit that no antianginal drug is superior to another is not fully adopted; and (c) the innovative way it condenses and expresses the relevant messages with eye-catching illustrations. Conclusions: The present article summarises and comments on the 123-page GLs, highlighting strengths and weaknesses according to the thoughts of the authors.
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