The European Society of Cardiology 2024 Guidelines on Chronic Coronary Syndromes: A Critical Appraisal

Background: During the 2024 annual meeting in London, The European Society of Cardiology released new guidelines (GLs) on chronic coronary syndromes (CCSs) and simultaneously published them in the European Heart Journal. Method: A few experts on the topic from Europe, South America, India, and Asia, who attended the presentation and the Question and Answer sections, met virtually to comment on the GLs after carefully reading the 123-page document. Result: There is a consensus that the presented GLs are a comprehensive, up-to-date, clear document of the available data on how to diagnose and treat CCSs and a definite step forward compared to all previous GLs. Of particular value are (a) the efforts to link both diagnosis and treatment to the underlying pathophysiology with the recognition that not all the ischaemic episodes are the same; (b) the decision to adopt the graphic of the so-called “Diamond Approach”, although its spirit that no antianginal drug is superior to another is not fully adopted; and (c) the innovative way it condenses and expresses the relevant messages with eye-catching illustrations. Conclusions: The present article summarises and comments on the 123-page GLs, highlighting strengths and weaknesses according to the thoughts of the authors.