Chronic Coronary Syndromes Clinical Practice Guidelines (2019)

European Society of Cardiology

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 04, 2019

In August 2019, the European Society of Cardiology (ESC) released updated recommendations to their 2013 guidelines for the diagnosis and management of chronic coronary syndromes (CCS) (formerly stable coronary artery disease [CAD]).[1,2]

The ESC introduced the term CCS in 2018 for what has been known as stable CAD to bring the terminology more in line with contemporary understanding of its development, progression, and management. The ESC indicates that “the clinical presentations of CAD can be categorized as either acute coronary syndrome (ACS) or CCS,” and that “CAD is a dynamic process” of atherosclerosis and altered arterial function “that can be modified by lifestyle, pharmacological therapies, and revascularization, which result in disease stabilization or regression.” CCS is also viewed as a type of out-of-hospital counterpart to ACS.

The updated guidelines define six clinical scenarios that reflect the heterogeneous nature of CCS, each defined by its own set of diagnostic and therapeutic concerns, as follows:

  • Suspected CAD with "stable" anginal symptoms, with or without dyspnea

  • Suspected CAD with new-onset heart failure symptoms or left ventricular (LV) dysfunction

  • Asymptomatic or stabilized symptomatic within 1 year of an ACS episode or following recent coronary revascularization

  • Asymptomatic or symptomatic more than 1 year after the initial diagnosis or revascularization

  • Angina and suspected vasospastic or microvascular disease

  • Asymptomatic with CAD detected at screening

The new phrase “clinical likelihood of CAD” uses various CAD risk factors as modifiers of pretest probability (PTP).

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