ESC Congress in Review - Main Edition 2019 - 7

ESC Congress 2019 In Review

Figure 2. Chronic Coronary Syndromes: 6 Common Scenarios at Outpatient Clinics

Patients with
suspected CAD
and 'stable' anginal
symptoms, and/or
dyspnoea

Patients with new
onset of HF or LV
dysfunction and
suspected CAD

Patients with
stabilised
symptoms < 1
year after an
ACS or patients
with recent
revascularisation

Patients
> 1 year afer initial
diagnosis or
revascularisation

Patients with
angina and
suspected
vasopastic or
microvascular
disease

Asymptomatic
subjects in
whom CAD is
detected at
screening

ACS, acute coronary syndrome; CAD, coronary artery disease; HF, heart failure; LV, left ventricular.
Reproduced with kind permission from Dr D. Capodanno.

* advances in imaging; both anatomy and function are
available invasively and non-invasively, and the role of
CT is increasing;
* intensified antithrombotic therapy; and
* revascularisation using PCI has prognostic impact on
the prevention of myocardial infarction.
The diagnosis of CCS has evolved significantly since the
2013 guidelines. The 6 most frequently encountered clinical
scenarios are outlined in Figure 2; each of which requires
different diagnostic and therapeutic approaches. A stepwise approach to diagnosis and treatment of a symptomatic patient with suspected CAD is recommended (Figure 3).
Treatment of CCS demands long-lasting healthy lifestyle behaviours, medication adherence, and interventions in selected patients. Statins are recommended in
all patients and antithrombotic drugs in most patients.
Revascularisation is important for patients at high risk, and

for those whose symptoms are not controlled through lifestyle and medication. Finally, the guidelines recommend a
schematic follow-up protocol that could be implemented
in clinical practice.
Replay presentation on ESC365

Diabetes and Cardiovascular Diseases
The 2019 ESC Guidelines on diabetes, pre-diabetes, and
cardiovascular diseases (CVD) [Cosentino F et al. Eur
Heart J. 2019] were developed in collaboration with the
European Association for the Study of Diabetes (EASD)
by a joint Task Force led by Francesco Cosentino, MD,
PhD, Karolinska Institute, Stockholm, Sweden, and Peter
J Grant (EASD Co-Chairperson), MD, University of Leeds,
Leeds, United Kingdom. The 2019 guidelines provide
information on how to prevent and manage the effects of
diabetes on the heart and vasculature.

Figure 3. Algorithm for Diagnostic Testing
Offer diagnostic testing

No diagnostic
testing mandated
Very low

Coronary CTA
Choice of the test based on
clinical likelihood, patient
characteristics and preference,
availability, as well as local
expertise

Invasive
angiography
(with iwFR/FFR)

Testing for ischaemia
(imaging testing preferred)

Clinical likelihood of obstructive CAD

Very high

CAD, coronary artery disease; CTA, computed tomography angiography; FFR, fractional flow reserve; iwFR, instantaneous wave-free ratio.
Reproduced and modified from Knuuti J et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019. Doi:10.1093/
eurheartj/ehz425. By permission of Oxford University Press on behalf of the European Society of Cardiology.

Official Peer-Reviewed Highlights From ESC Congress 2019

https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/2019-ESC-Guidelines-Overview/191071-2019-esc-guidelines-on-chronic-coronary-syndromes#video https://doi.org/10.1093/eurheartj/ehz425 https://doi.org/10.1093/eurheartj/ehz425

ESC Congress in Review - Main Edition 2019

Table of Contents for the Digital Edition of ESC Congress in Review - Main Edition 2019