2019 Guidelines on Chronic Coronary Syndromes

ESC Clinical Practice Guidelines

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented refer to the management of patients with CCS.

Topic(s):

Coronary Artery Disease (Chronic)

CV Surgery - Coronary Arteries

Guidelines version available to download

Full text

Published in 2019

Reference

Web addenda

Published in 2019

Reference CCS

Corrigendum

Published in 2019

Reference CCS

Related materials

Published in 2019

Reference Questions & Answers 2019 CCS Guidelines

Pocket guidelines

Published in 2019

Reference

Slide-set

Published in 2019

Reference 2019 Slides on CCS

Declarations of interest

Endorsed by cardiac societies

Belgian Society of Cardiology , Croatian Cardiac Society , French Society of Cardiology , German Cardiac Society , Hungarian Society of Cardiology , Italian Federation of Cardiology , Polish Cardiac Society , Portuguese Society of Cardiology , Romanian Society of Cardiology , Russian Society of Cardiology , Cardiology Society of Serbia , Slovak Society of Cardiology , Spanish Society of Cardiology , Turkish Society of Cardiology , Ukrainian Association of Cardiology

Table of contents: Full Text (ESC Clinical Practice Guidelines)

Table of contents of the 2019 Guidelines on Chronic Coronary Syndromes
Preamble
Introduction
- What is new in the 2019 Guidelines?
Patients with angina and/or dyspnea, and suspected coronary artery disease
- Basic assessment, diagnosis, and risk assessment
  - Step 1: symptoms and signs (Stable unstable angina, distinction between symptoms caused by epicardial vs microvascular/vasospastic disease)
  - Step 2: Comorbidities and other causes of symptoms
  - Step 3: Basic testing 'Biochemical tests, resting electrocardiogram and ambulatory monitoring, echocardiography and magnetic resonance imaging at rest, chest X-ray)
  - Step 4: assess pre-test probability and clinical likelihood of coronary artery disease
  - Step 5: Select appropriate testing (functional non-invasive tests, anatomical non-invasive evaluation, role of the exercise electrocardiogram, selection of diagnostic tests, the impact of clinical likelihood on the selection of a diagnostic test, invasive testing, definition of levels of risk)
- Lifestyle management
  - General management of patients with coronary artery disease
  - Lifestyle modification and control of risk factors
    - Smoking
    - Diet and alcohol
    - Weight management
    - Physical activity
    - Cardiac rehabilitation
    - Psychosocial factors
    - Environmental factors
    - Sexual activity
    - Adherence and sustainability
    - Influenza vaccination
- Pharmacological management
  - Anti-ischaemia drugs
    - General strategy
    - Available drugs
    - Patients with low blood pressure
    - Patients with low heart rate
  - Event prevention
    - Antiplatelet drugs
    - Anticoagulant drugs in sinus rhythm
    - Anticoagulant drugs in atrial fibrillation
    - Proton pump inhibitors
    - Cardiac surgery and antithrombotic therapy
    - Non-cardia surgery and antithrombotic therapy
  - Statins and other lipid-lowering drugs
  - Renin-angiotensin-aldosterone system blockers
  - Hormone replacement therapy
- Revascularization
Patients with new-onset of heart failure or reduced left ventricular function
Patients with a long-standing diagnosis of chronic coronary syndromes
- Patients with stabilized symptoms <1 year after an acute coronary syndrome or patients with recent revascularization
- Patients >1 year after initial diagnosis or revascularization
Angina without obstructive disease in the epicardial coronary arteries
- Microvascular angina
  - Risk stratification
  - Diagnosis
  - Treatment
- Vasospastic angina
  - Diagnosis
  - Treatment
Screening for coronary artery disease in asymptomatic subjects
Chronic coronary syndromes in specific circumstances
- Cardiovascular comorbidities
  - Hypertension
  - Valvular heart disease (including planned transcatheter aortic valve implantation)
  - After heart implantation
- Non-cardiovascular comorbidities
  - Cancer
  - Diabetes mellitus
  - Chronic kidney disease
  - Elderly
- Sex
- Patients with refractory angina
Key messages
Gaps in evidence
"What to do" and "what not to do" messages from the Guidelines
Supplementary data
Appendix
References

Previous version available to download

Full text

Published in 2013

Reference Eur Heart J 2013;34:2949–3003 - doi:10.1093/eurheartj/eht296

Related materials

Published in 2013

Reference Web Addenda

Corrigendum

Published in 2014

Reference Corrigendum SCAD

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2019 Guidelines on Chronic Coronary Syndromes

ESC Clinical Practice Guidelines