The 2024 European Society of Cardiology (ESC) Guidelines on the management of chronic coronary syndromes (CCS) include a focus on both larger and smaller blood vessels of the heart; new models to estimate chances of blocked large arteries (so-called obstructive coronary artery disease); optimal selection and sequence of tests; drugs and interventions to prevent disease complications and improve symptoms, and the fundamental role of patient involvement. "The new guidelines prompt cardiologists to rethink chronic coronary syndromes as caused not only by blockages in large arteries but also by dysfunction of smaller vessels (microcirculation)," explains Guidelines co-chair Professor Christiaan Vrints, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. "Over half of individuals suspected of CCS may have angina/ischemia with nonobstructive coronary arteries (ANOCA/INOCA) caused by coronary artery spasm or microcirculatory dysfunction.
This condition is often missed—on average it is diagnosed only after seeing three cardiologists—because the usual tests don't work well to detect it. Patients may suffer severely from persistent symptoms that can cause repeated hospitalizations and even heart failure." Published in the European Heart Journal , the guidelines highlight that persistently symptomatic patients with suspected ANOCA/INOCA who do not respond to guideline-derived medical therapy should undergo invasive coronary functional testing to determine underl.