2024 ESC Guidelines for the management of chronic coronary syndromes

30 Aug, 2024

The current guidelines for managing chronic coronary syndromes (CCS) are intended to assist in diagnosing and initiating treatment for individuals with suspected CCS, as well as in the longterm management of patients with confirmed CCS.

These guidelines recommend using a risk factor-weighted clinical likelihood model to estimate the most up-to-date clinical likelihood of obstructive coronary artery disease (CAD). Compared to the basic 2019 ESC pre-test probability model, incorporating risk factors into the pre-test likelihood model (which considers age, sex, and symptoms) enhances the prediction of obstructive CAD. This approach reclassifies more individuals into the very low and low likelihood categories, where further testing may be unnecessary. An updated diagnostic algorithm is provided for patients with moderate or high pre-test likelihood. The Guidelines also include an expanded section on diagnosing and treating patients with angina and no or nonobstructive coronary artery disease, now termed ANOCA-INOCA. The treatment section offers guidance on anti-anginal/anti-ischaemic medications and various event-preventing therapies. It also covers strategies to improve adherence to medical treatment and prescribed lifestyle changes. Additionally, the guidelines review indications for and selection of the optimal revascularisation modality based on findings from large RCTs and IPDAs. Lastly, options for managing recurrent or refractory angina/ischaemia are discussed.

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