ESC 2019 — In a first, new chronic coronary disease guidelines highlight air and noise pollution


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Reflecting shifts in emphasis, updated chronic coronary disease guidelines from the European Society of Cardiology (ESC) highlight air and noise pollution for the first time.
  • The new title of the guidelines uses “chronic coronary syndromes” (CCS) rather than “stable coronary artery disease” (CAD).
  • The full guidelines, which debuted at ESC 2019, are available here; a pocket version is available here, and clinicians can also download the ESC mobile pocket guidelines app. 

Why this matters

  • The name change reflects that “stable” CAD actually can be dynamic and is lifelong, said William Wijns, a task force chair, in a statement. 

Key highlights

  • New additions to the guidelines are listed here, along with class of indication.
    • Example: coronary CT angiography/noninvasive functional imaging in suspected CAD is now a class I indication in symptomatic patients, with the decision based in part on pretest probability.
  • Changes to the earlier guidelines are listed here, and include changes in indicated uses of exercise ECG.
  • Guidelines offer “what to do" and "what not to do” messages for clinicians. 
    • Example: 
      • Do use ambulatory ECG with chest pain and suspected arrhythmias.
      • Do not use ambulatory ECG routinely in suspected CCS.
  • The new guidelines also focus more than before on lifestyle modifications to prevent CCS progression, including smoking cessation, avoidance of passive smoking, healthy diet, and annual influenza vaccination.
  • Patients with CCS should avoid areas with heavy traffic, consider wearing a respirator face mask, and use high-efficiency air purifiers indoors, said Wijns. 

Additional note