ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes

Abstract

The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of “clinical likelihood of CAD” was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms.

Quantitative Flow Ratio Is Related to Intraluminal Coronary Stenosis Parameters as Assessed with Optical Coherence Tomography

“…Chronic coronary syndromes (CCS) are stable manifestations of coronary artery disease (CAD). In CCS, revascularization is indicated with proof of ischemia [ 1 , 2 ]. This may be obtained by means of non-invasive testing, such as stress echocardiography, single-photon emission computerized tomography or cardiac magnetic resonance.…”

“…This may be obtained by means of non-invasive testing, such as stress echocardiography, single-photon emission computerized tomography or cardiac magnetic resonance. On the other hand, invasive coronary angiography with functional testing using a pressure wire remains the gold standard to assess a lesion’s hemodynamic relevance [ 2 ]. Different wire based types of functional tests are currently employed such as fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), or resting full-cycle ratio (RFR); however, these types of tests inherently bear a relevant risk of coronary vessel damage due to the necessity of wire advancement into the coronary artery and past the coronary stenosis, which may potentially cause vascular complications as dissections or plaque activation.…”

Prognosis of stent implantation on variant angina with severe organic stenosis

“…The effective rate of CCB in VA patients in Japan was 92.5% [16] which is similar to our stenting group (88%)and stent-free group(89%) Other literatures reported that aspirin, statins and ACEi could prevent spasm and improve the prognosis of patients [17][18][19] . In addition, we included VA patients,whose diagnostic criteria included resting angina and transient elevation of ST segment one ECG without spasm provocation test, but could be diagnosed as VA with high specificity [10,20,21] , it has been reported that provocation test is safe and effective for VA patients with no significant stenosis [22] ,but provocation test has more advantages than disadvantages for VA patients with severe stenosis [23] , We believe that provocation test may lead to unstable plaque shedding, which increases the incidence of MACE and affects the results of the trial. Most of the studies mentioned in this paper are diagnosed as VSA by provocation test, but ST-segment depression is more common than elevation during coronary spasm [24] , so we don't think the two situations should be studied together.…”

Real-time coronary artery stenosis detection based on modern neural networks

“…Despite novel imaging modalities (e.g. coronary CT angiography) have been developed, invasive coronary angiography is the preferred diagnostic tool to assess the extent and severity of complex coronary artery disease according to the 2019 guidelines of the European Society of Cardiology 5 , 6 . Multivessel coronary artery disease affecting two or more coronary arteries requires interpretive expertise on the assessment of multiple parameters (the number of affected major coronary arteries, the location of lesions, the severity of stenosis, the length of the stenotic segment, tortuosity, etc.)…”