The latest European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS) mark a significant shift in how cardiologists approach and treat heart conditions
Released today, these guidelines emphasise a comprehensive approach to managing both traditional large artery blockages and emerging issues related to smaller blood vessel dysfunction within the heart.
CCS has been synonymous with obstructive coronary artery disease (CAD), where blockages in major heart arteries cause symptoms like angina.
However, the new guidelines, co-chaired by Professor Christiaan Vrints of Antwerp University Hospital, Belgium, show that over half of patients suspected of CCS may suffer from nonobstructive coronary artery disease (ANOCA/INOCA). These conditions, often missed by standard tests, involve either coronary artery spasms or dysfunction in the microcirculation, leading to persistent symptoms and recurrent hospitalisations.
Risk assessment tool
To address these complexities, the guidelines advocate for advanced diagnostic models and technologies. A new risk assessment tool, integrated into the guidelines, helps predict the likelihood of obstructive CAD more accurately than previous models, optimising the selection of diagnostic tests. For instance, coronary computed tomography angiography (CCTA) is highlighted as highly effective in ruling out significant artery blockages or assessing the risk of cardiovascular events based on disease anatomy.
In cases where CCTA shows intermediate blockages, additional stress tests such as echocardiography or cardiac magnetic resonance imaging are recommended to evaluate the functional impact, especially for diagnosing ANOCA/INOCA. For patients with confirmed large artery blockages, the guidelines stress the importance of personalised treatment strategies, including surgical or percutaneous interventions based on individual clinical profiles and anatomical considerations.
According to Professor Felicita Andreotti from the Catholic University Medical School, Rome, Italy, who co-chairs the guidelines, the recommendations for coronary revascularisation remain largely unchanged from previous editions. Surgical intervention is preferred for patients with extensive disease, diabetes, or reduced heart function, whereas percutaneous procedures benefit from advanced imaging techniques to enhance precision and long-term outcomes.
Chronic coronary syndromes pacients treatment decisions
Beyond procedural advancements, the guidelines place a strong emphasis on patient education and involvement in treatment decisions. Professors Vrints and Andreotti emphasize the potential of mobile-health interventions and simplified medication regimens to improve patient adherence and long-term monitoring, crucial for managing disease complications effectively.
In conclusion, these guidelines represent a pivotal update in the field of cardiovascular medicine, aiming to reduce mortality rates associated with coronary syndromes globally. By integrating cutting-edge diagnostic tools, personalised treatment approaches, and enhanced patient engagement strategies, the ESC sets a new standard for managing chronic coronary syndromes in the 21st century.
