- 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.
- 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.
- 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.
- This article provides only highlights; clinicians should consult the complete guidelines for details.