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New ESC Guidelines on stable coronary artery disease 

ESC Congress News 2013 - Amsterdam

Topics: Chronic Ischaemic Heart Disease (IHD)
Date: 01 Sep 2013
THE NEW ESC GUIDELINES on the Management of Stable Coronary Artery Disease, whose Task Force has been chaired by Professors Gilles Montalescot and Udo Sechtem, will be presented today for the first time. The full text of the guidelines is available online at and with paginated reference in the European Heart Journal.

Marco Valgimigli, University Hospital of Ferrara, Italy 

Juhani Knuuti, Turku University Hospital, Finland

There are multiple reasons why we encourage you to attend this special session, which can be summarised as follows:

1. Since the previous release of the guidelines addressing the management and treatment of stable angina pectoris in 2006, the concept of stable coronary artery disease (SCAD) has evolved. Accordingly, SCAD has become a much broader terminology encompassing several groups of patients: those having stable angina pectoris or other symptoms felt to be related to coronary artery disease, such as dyspnoea; those previously symptomatic with known obstructive or non-obstructive CAD who have become asymptomatic with treatment and need regular follow-up; and those who report symptoms for the first time and are judged to be already in a chronic stable condition (for instance because history-taking reveals that similar symptoms were already present for several months). Hence, SCAD now defines the different evolutionary phases of CAD excluding the situations in which coronary artery thrombosis dominates clinical presentation (acute coronary syndromes).

2. The present guidelines focus separately on diagnostic testing and prognostic assessment. Many tests provide this information simultaneously (and not just diagnosis), as well as an indication of the severity of the disease and estimated prognosis. This major paradigm change is also driven by recent evidence questioning the prognostic implications of treatment strategies which were considered a must-do only few years ago.

3. The role of coronary revascularisation is extensively discussed and put into the context of recent evidence questioning the prognostic role of percutaneous coronary intervention or coronary artery bypass grafting in this low risk patient population.

4. These guidelines give increased and renewed importance to the pre-test probability of the disease. The estimation of pre-test probability has been updated according to recent evidence and is now strongly influencing the choice of diagnostic tests. The application of the revised diagnostic and prognostic algorithms streamline clinical decision-making and optimize resource utilization.

5. The importance of physiological assessment of CAD in the catheterisation laboratory is extensively discussed and practical algorithms for diagnostic and therapeutic purposes are presented.

6. Compared to the previous version, the new guidelines consider not only atherosclerotic narrowings but also microvascular dysfunction and coronary vasospasm in the diagnostic and prognostic algorithms. These entities have been partially forgotten by most recent literature. Yet, they continue to pose distinct challenges to clinicians both in terms of diagnostic and therapeutic workouts.

7. Lifestyle and pharmacological management have received great attention, and available options are thoroughly discussed. In particular, cardiac rehabilitation, influenza vaccination and hormone replacement therapy are addressed along with the current role of several pharmacological options, including ivabradine, nicorandil, trimetazidine and ranolazine.

8. There is special attention paid to challenging patient sub-groups, such as those with SCAD and low arterial pressure or with low heart rate. Moreover, women, diabetic patients, those with chronic kidney disease, elderly patients and those who have previously undergone coronary revascularisation have received in-depth attention.

New 2013 ESC Guidelines on stable coronary artery disease  1 Sep 16:30-18:00, Amsterdam - Central Village

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Authors: Dr Marco Valgimigli and Prof Juhanni Knuuti

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is “The Heart Interacting with Systemic Organs”.  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on the scientific programme.


Refers to session:  New 2013 ESC Guidelines on stable coronary artery disease