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In 2019, new Clinical Practice Guidelines are planned to replace the 2013 recommendations for the management of stable coronary artery disease.
As part of this comprehensive update, the Task Force, led by William Wijns and Juhani Knuuti, have proposed a change in nomenclature from ‘stable coronary artery disease’ to ‘chronic coronary syndromes (CCS)’. A key rationale is that although coronary artery disease (CAD) often seems ‘stable’ in between acute events, the underlying disease status is anything but ‘stable’. Atherosclerotic plaque accumulation is a dynamic process that can change over time to include growth, stabilisation or regression, as well as changes in plaque composition or thrombosis, depending on lifestyle, risk factor modulation and pharmacological therapies. The change to CCS has been proposed to more accurately represent this changing pathophysiology, for the better or the worse, over the continuum of the disease.
CCS will also better cover the different clinical presentations and multiple syndromes included in the 2019 Clinical Practice Guidelines. The guidelines will provide specific recommendations on the management of several different clinical scenarios, such as patients with suspected CAD, others with known chronic chest pain, asymptomatic and symptomatic patients with long-standing CAD and patients who have recently undergone successful revascularisation. All these, plus many more clinical scenarios, will be included in this new version of the Clinical Practice Guidelines and will be better classed under the umbrella term of CCS than being reduced to a single condition of ‘stable CAD’ or ‘stable angina’. As with heart failure, clinical presentations will be conveniently categorised as either acute or chronic coronary syndromes, accurately covering the different stages of the disease.
New for 2019: ESC Guidelines on the Management of Chronic Coronary Syndromes.
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