2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Abstract

AIM The “2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease” provides an update to and consolidates new evidence since the “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease” and the corresponding “2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease.” Methods A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Structure This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost–value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Chronic Coronary Disease Guidelines

“…Chronic Coronary Disease Guidelines Sunil V. Rao , MD; Harmony R. Reynolds , MD; Judith S. Hochman , MD C hronic coronary disease (CCD) affects millions of people worldwide and is responsible for significant morbidity, mortality, and costs. CCD as defined in the 2023 guideline 1 includes patients who may or may not have classic signs and symptoms of coronary artery disease. The 2023 guideline reflects this heterogeneity by including patients stabilized after acute coronary syndrome hospitalization; those with ischemic cardiomyopathy, stable angina or equivalent with or without a positive imaging test; vasospasm or microvascular disease; and positive noninvasive screening test leading to a clinician diagnosis of coronary artery disease .…”

“…Three class 3 recommendations in the CCD guidelines, pertaining to routine testing in patients who do not have a change in clinical or functional status, are notable: (1) no benefit of routine periodic testing with coronary computed tomography angiography or stress testing; (2) no benefit of periodic assessment of LVEF; and (3) harm for routine coronary angiography in this setting. Randomized and observational studies have shown no benefit of routine testing follow-up for ischemia, anatomical progression of coronary artery disease, or LV function in stable patients with CCD.…”

Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring

“…4 Notably, this possible ancillary role of ExECG is also echoed in American guidelines for patients with chronic coronary syndromes. 67 Some hindrances should be acknowledged when considering the use of ExECG in the assessment of suspected CAD. 16,57,63,68,69 First, technical issues such as ECG quality or baseline abnormalities (including left bundle branch block or ventricular pacing, both of which could affect interpretation) should be considered.…”

Plasma Metabolic Profiling and Multiclass Diagnostic Model Development for Stable Angina Pectoris and Acute Myocardial Infarction

“…Another diagnostic limitation in clinical practice is the ineffective allocation and poor use of medical resources. CHD diagnosis depends predominantly on coronary CT angiography (CTA) or angiography alone . However, a subset of patients who presented with chest pain symptoms and underwent pertinent tests exhibited no coronary artery abnormalities .…”