2024 ESC Guidelines for the management of chronic coronary syndromes

Key points The usage of drug coated balloon (DCB) is escalating globally, but the data mainly exists for certain lesion and patient subsets; in‐stent restenosis, small vessel disease, high bleeding risk patients and bifurcation lesions. As of now there is lack of data on the use of DCB in large vessels and we are sceptical whether we can prove superiority over current generation DES especially in large vessels, but we eagerly look forward to the results of upcoming randomized control trials (Selution de novo and Transform II) The DCB believers and experienced operators have the responsibility to nurture and look after this relatively novel technology so that its future use and reproducibility of the results are consistent across the globe. To facilitate this, we have to abide by the current evidence and work toward generating new evidence to support and carry the technology forward.

Is the enthusiasm for Drug‐Coated balloon technology justified?

Basavarajaiah,

Bhatia,

Cortese

et al. 2024

Developing a Women's Heart Center With a Specialization in Coronary Microvascular and Vasomotor Dysfunction: If You Build It, They Will Come

Tapp,

Ashokprabhu,

Hamstra

et al. 2024

BackgroundWomen's Heart Centers (WHC) are comprehensive, multidisciplinary care centers designed to close the existing gap in women's cardiovascular care. The WHC at The Christ Hospital Heart and Vascular Institute (TCH‐WHC) in Cincinnati, Ohio was established in October of 2020, and is a specialized coronary microvascular and vasomotor dysfunction (CMVD) program.MethodsThe TCH‐WHC focuses its efforts across five pillars: patient care, research, education, community outreach and advocacy, and grants and philanthropy. These areas, centered around providing specalized CMVD care and treatment have allowed for substantial growth.ResultsFrom October 2020‐December 2023, TCH‐WHC saw a total of 3219 patients, 42% of which were apart of the CMVD program. Since establishment, patient volume has consistently increased year over year.ConclusionThe CMVD program at TCH‐WHC is one of the fastest growing in the U. S. and is nationally recognized for specialized clinical care, diagnostics, and research. The goal of this review is to provide an overview of the TCH‐WHC structure that allows for the establishment and growth of a CMVD program and to outline core activities supporting the TCH‐WHC approach.

Utilizing Invasive Coronary Functional Testing in a Coronary Microvascular and Vasomotor Dysfunction Program: Methods and Considerations

Quesada,

Ashokprabhu,

Tapp

et al. 2024

BackgroundCoronary microvascular and vasomotor dysfunction (CMVD) is associated with a threefold increased risk of major adverse cardiovascular events (MACE) and is the primary mechanism responsible for angina/ischemia in patients with nonobstructive coronary artery disease (ANOCA/INOCA). Proper assessment for CMVD is vital to provide targeted treatment and improve patient outcomes. Invasive coronary functional testing (ICFT) is the “gold standard,” for CMVD assessment and can be used to diagnose all endotypes. However, there is a lack of standardization for ICFT protocols and use in the treatment of CMVD.AimsTo provide a comprehensive overview of ICFT protocols utilized at the Christ Hospital Womens Heart Center (TCH‐WHC).MethodsHere, we outline our standard operating procedures for ICFT utilized at TCH‐WHC, including the procedures two main methods: Doppler and Thermodilution. We describe our structured approach for ICFT referral and postdiagnostic clinical management utilized at The Christ Hospital Women's Heart Center (TCH‐WHC) CMVD program. We then quantified how ICFT has contributed to growth of the TCH‐WHC.ResultsFrom October of 2020 until July of 2024, a total of 422 patients have undergone ICFT at TCH‐WCH, 64% were performed via the Doppler protocol and 36% were performed via the Thermodilution protocol. Based on exclusive endotype categories, 19% had an endothelial‐independent CMD alone, 19% had endothelial‐dependent CMD or microvascular VSA alone, 3% had epicardial VSA alone, 42% had mixed disease (any combination of the above categories), and 17% had a normal ICFT.ConclusionsICFT provides opportunity to provide diagnostic clarity and optimize medical treatment for CMVD. TCH‐WHC's structured approach for ICFT referral and protocol for conducting comprehensive ICFT which has been vital for the growth of our specialized CMVD program.