[Chronic coronary syndrome - new ESC guidelines]

Area of Science:

• Cardiology
• Medical Guidelines
• Diagnostic Imaging

Background:

• Chronic coronary syndrome (CCS) management requires updated strategies for risk stratification and treatment.
• Previous guidelines lacked specific recommendations for first-line diagnostic modalities in varying probability scenarios.
• Persistent angina in non-obstructive coronary artery disease necessitates further investigation.

Purpose of the Study:

• To present the 2024 European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS).
• To outline updated recommendations for risk assessment, diagnosis, and treatment of CCS.
• To emphasize proactive management to reduce future cardiovascular events.

Main Methods:

• Development of a risk factor-based clinical probability model for CCS assessment.
• Recommendation of coronary CT angiography (CCTA) as the first-line diagnostic tool for low-to-moderate probability of coronary artery disease (CAD).
• Guidance on utilizing functional tests (stress echocardiography, PET-CT, perfusion MRI) for moderate-to-high probability CAD, based on availability.

Main Results:

• Introduction of a novel risk factor-based clinical probability model for CCS.
• Coronary CT angiography (CCTA) is recommended as the primary diagnostic modality for low-to-moderate probability CAD.
• High-intensity lipid-lowering therapy targeting LDL < 1.4 mmol/L is advised for all CCS patients.
• Further microcirculation investigation is suggested for persistent angina in non-obstructive CAD.

Conclusions:

• The 2024 ESC guidelines provide a comprehensive framework for managing chronic coronary syndrome.
• Active assessment and treatment, guided by risk stratification and appropriate diagnostic pathways, are crucial for improving patient outcomes.
• Personalized treatment strategies, including aggressive lipid management and targeted investigations, are emphasized for CCS patients.