2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes:

The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC)

European Heart Journal — January 14, 2020

Authors: Juhani Knuuti, William Wijns, Antti Saraste, Davide Capodanno, Emanuele Barbato, Christian Funck-Brentano, Eva Prescott, Robert F Storey, Christi Deaton, Thomas Cuisset et al

European Heart Journal, Volume 41, Issue 3, 14 January 2020, Pages 407–477, https://doi.org/10.1093/eurheartj/ehz425

New/revised concepts in 2019

The Guidelines have been revised to focus on CCS instead of stable CAD.

This change emphasizes the fact that the clinical presentations of CAD can be categorized as either ACS or CCS. CAD is a dynamic process of atherosclerotic plaque accumulation and functional alterations of coronary circulation that can be modified by lifestyle, pharmacological therapies, and revascularization, which result in disease stabilization or regression.

In the current Guidelines on CCS, six clinical scenarios most frequently encountered in patients are identified: (i) patients with suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea; (ii) patients with new onset of HF or LV dysfunction and suspected CAD; (iii) asymptomatic and symptomatic patients with stabilized symptoms <1 year after an ACS or patients with recent revascularization; (iv) asymptomatic and symptomatic patients >1 year after initial diagnosis or revascularization; (v) patients with angina and suspected vasospastic or microvascular disease; (vi) asymptomatic subjects in whom CAD is detected at screening.

The PTP of CAD based on age, gender and nature of symptoms have undergone major revisions. In addition, we introduced a new phrase ‘Clinical likelihood of CAD’ that utilizes also various risk factors of CAD as PTP modifiers. The application of various diagnostic tests in different patient groups to rule-in or rule-out CAD have been updated.

The Guidelines emphasize the crucial role of healthy lifestyle behaviours and other preventive actions in decreasing the risk of subsequent cardiovascular events and mortality.