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Updated: May 23, 2025

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[Chronic coronary syndrome in 2025: from atherosclerosis to microcirculation]

Aurelia Zimmerli1, Adil Salihu1, Quentin Liabot1

  • 1Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne.

Revue Medicale Suisse
|May 22, 2025
PubMed

Insights

Chronic coronary syndrome (CCS) involves coronary dysfunction causing ischemia. Diagnosis differentiates obstructive from non-obstructive coronary artery disease, with challenging treatment for the latter.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Ischemic Heart Disease

Context:

  • Chronic coronary syndrome (CCS) encompasses coronary artery or microcirculatory dysfunction leading to myocardial ischemia.
  • It includes patients with prior revascularization procedures.
  • Diagnosis differentiates obstructive coronary artery disease from non-obstructive forms like Angina with Non-Obstructive Coronary Arteries (ANOCA) and Ischemia with Non-Obstructive Coronary Arteries (INOCA).

Purpose:

  • To outline the diagnostic and management strategies for Chronic Coronary Syndrome.
  • To highlight the challenges in diagnosing and treating non-obstructive coronary artery disease.
  • To emphasize the need for an individualized approach in managing CCS.

Summary:

  • CCS diagnosis involves clinical evaluation and non-invasive/invasive testing to identify epicardial obstructive disease versus ANOCA/INOCA.
  • Management strategies include risk factor optimization, antianginal medications, and revascularization when indicated.
  • Treating non-obstructive CCS remains complex, necessitating personalized therapeutic plans.

Impact:

  • Improved understanding of CCS diagnosis and management.
  • Highlights the clinical significance of differentiating obstructive and non-obstructive coronary artery disease.
  • Informs clinical practice regarding individualized treatment for challenging non-obstructive cases.

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