New 2019 ESC Guidelines for Diagnosis and Management of Chronic Coronary Syndromes (review)

Chronic stable angina (CCS) is the most prevalent symptom of ischaemic heart disease and its management is a priority. CCS are defined by the different evolutionary phases of CAD, excluding situations in which an acute coronary artery thrombosis dominates the clinical presentation (i.e ACS).

The most frequently encountered clinical scenarios in patients with suspected or established CCS are: 1) CAD patients with suspected CAD and ''stable'' anginal symptoms, and/or dyspnoea; 2) patients with new onset of heart failure or left ventricular dysfunction and suspected CAD;3) asymptomatic and symptomatic patients with stabilized symptoms <1 year after ASC or patients with recent revascularization;4) asymptomatic and symptomatic patients > 1 year after initial diagnosis or revascularization; 5) patients with angina and suspected vasospastic or microvascular disease; 6) and asymptomatic subjects in whom CAD is screening.

Тhе new technologies improve the results of treatment of these patients. Authors used determinants of the clinical likelihood of obstructive coronary artery disease and suggested stepwise strategy for long-term anti-ischemic drug therapy in patients with CCS and specific baseline characteristics.

Current guidelines recommend pharmacological therapy with drugs classified as being first line (beta blockers, calcium channel blockers, short acting nitrates) or second line (long-acting nitrate, ivabradine, nicorandil, ranolazine and trimetazidine). Second line drugs are indicated for patients who have contraindications to first line agents, do not tolerante them or remain symptomatic. Patients with angina pectoris due coronary artery disease should also detreated with low dose aspirin and a statin. The demonstrated effect of the drugs include disease clinical manifestation, reduction and decrease of cardiovascular incidence and mortality rates.

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