Summary of the 2025 ESC Guidelines for Chronic Coronary Syndrome
This article summarizes the updated European Society of Cardiology (ESC) guidelines for Chronic Coronary syndrome (CCS). Here’s a breakdown of the key takeaways:
1. Lipid Management:
LDL Target: <1.4 mmol/L with at least a 50% reduction from baseline. Thrombocyte Treatment: Lifelong low-dose acetylsalicylic acid is recommended for patients with revascularization, heart attack, or significant stenoses.
2. Novel Treatments & Diabetes/Obesity Management:
Semaglutide Consideration: Treatment with Semaglutide should be considered for patients with BMI > 27 or obesity, even without diabetes. (Note: currently not subsidized in sweden for this indication).
SGLT2 inhibitors/GLP-1 agonists: Continue to be recommended for Type 2 Diabetes patients to prevent cardiovascular events.
3. Revascularization (PCI/Surgery):
Prognostic Benefit: Revascularization shows benefit only in cases of main stem stenosis,three-vessel disease,or disease in the proximal LAD.
Symptom Relief: For other locations, revascularization is recommended only if optimal antianginal treatment is insufficient.
4.Inflammation:
highly Sensitive CRP: Highlighted as an vital investigation, though not yet routine in Sweden.
Anti-inflammatory Treatment: Consideration of anti-inflammatory treatment (colchicine) for high ischemic risk/recurring illness after specialist assessment. However, recent studies have cast doubt on colchicine’s benefit post-heart attack.
5. Angina with Non-Obstructive Coronary Arteries (ANOCA/INOCA):
New Terminology: Introduction of ANOCA (angina, no obstructive disease) and INOCA (ischemia, no obstructive disease). These encompass conditions like vasospastic angina and microvascular dysfunction. Investigation: Microcirculation investigation is recommended for persistent angina.
Treatment (Microvascular Dysfunction): Nitrates, calcium channel blockers, beta-blockers, and risk factor management. Ivabradine is the only available second-line antianginal drug in Sweden.
6. Diagnostic Approach & Implementation:
New Algorithm: A new algorithm emphasizes risk factors and clinical assessment to evaluate the probability of obstructive coronary heart disease.
* CT Coronary Angiography (CTCA): Recommended as the standard method for most patients with suspected coronary heart disease. Wider access to CTCA is needed in Sweden for full implementation.
Disclosure: The article notes potential conflicts of interest for Sara Bentzel and moa Simonsson, including speaker fees and advisory board compensation from various pharmaceutical companies.
