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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.

Coronary Artery Disease (Chronic)
CV Surgery - Coronary Arteries
Guidelines version available to download
Published in 2019
Reference 
Published in 2019
Reference 
Published in 2019
Reference CCS
Published in 2019
Reference 
Published in 2013
Reference Eur Heart J 2013;34:2949–3003 - doi:10.1093/eurheartj/eht296
Published in 2014
Reference Corrigendum SCAD
Published in 2013
Reference Web Addenda
Table of contents: Full Text (ESC Clinical Practice Guidelines)
  • 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