New ESC Guidelines on Management of SCAD Released
On Aug. 30, the European Society of Cardiology (ESC) released the 2013 guidelines on the management of stable coronary artery disease (SCAD). Published in the European Heart Journal and presented at the ESC Congress 2013 in Amsterdam, the guidelines update the 2006 ESC guidelines since the management and treatment of SCAD has evolved.
Specifically, the new guidelines include new imaging techniques such as cardiovascular magnetic resonance (CMR) and coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) in patients with stable chest pain. The guidelines “also clearly define which patients should receive coronary CT angiography to avoid overuse of this technique.”
They also focus on diagnostic testing and prognostic assessment, the role of coronary revascularization, emphasizes the importance of pre-test probability of SCAD and physiological assessment of CAD in the catheterization laboratory, and consider “not only atherosclerotic narrowings but also microvascular dysfunction and coronary vasospasm in the diagnostic and prognostic algorithms.”
Further, lifestyle and pharmacological management options are discussed, “in particular, cardiac rehabilitation, influenza vaccination and hormone replacement therapy … along with the current role of several pharmacological options, including ivabradine, nicorandil, trimetazidine and ranolazine.”
The management of SCAD in patient sub-groups is also discussed, including women, patients with diabetes or chronic kidney disease, elderly patients, and patients who have previously undergone coronary revascularization.
“We hope these guidelines will make practitioners dealing with patients with stable chest pain and other forms of stable coronary artery disease think more often of functional coronary disease which then should be treated appropriately,” said Professor Udo Sechtem, chair of the Task Force. “Moreover, patients at high pre-test probability do not need to undergo a battery of tests before being directed to invasive coronary angiography on clinical evidence only. Of course, revascularization in such patients should be directed by using fractional flow reserve measurements liberally.”
In addition, “we hope that overuse of coronary CT angiography will be discouraged by the clear definition of a patient group at the lower range of intermediate pretest probabilities in whom this technique may be helpful for excluding stenosis,” he adds.
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