The 2019 ESC Guidelines emphasize individualized management of chronic coronary syndromes in the presence of non-cardiovascular comorbidities to optimize safety and efficacy.
Clinicians must personalize anti-ischaemic therapy for comorbid patients; extends ESC framework for tailored CCS management.
С areful evaluation of patient history, including of anginal symptoms, and evaluation of risk factors and manifestation of coronary artery disease (CAD), as well as proper physical examination and basic testing, are crucial for the diagnosis and management of chronic coronary syndrome(s) (CCS) and non-cardiovascular comorbidities. Anti-ischaemic treatment must be adapted to the individual patient based on comorbidites, co-administered therapies, expected tolerance and adherence, and patient preferences. The choice of anti-ischaemic drugs to treat chronic coronary sydromes should be adapted to the patient’s heart rate, blood pressure, and left-ventricular (LV) function. In patients with active cancer treatment decisions should based on life be expectancy, additional comorbidities such as thrombocytopenia, increased thrombosis propensity. and potential interactions between drugs used in CCS management and antineoplastic agents. In asymptomatic patients with diabetes mellitus, a periodic resting electrocardiogram is recommended for cardiovascular detection of conduction abnormalities, atrial fibrillation, and silent myocardial infarction. Recommendations for chronic kidney disease (CRD): use iodinated contrast agents is minimized in patients with severe CKD and preserved urine production to prevent further deterioration. It is recommended that particular attention is paid to side effects of drugs, intolerance, and overdosing in elderly patients with chronic coronary syndromes. Hormone replacement therapy is not recommended for risk reduction in post- menopausal women. Тransmyocardial revascularization is not recommended in patients with debilitating angina refractory to optimal medical and revascularization strategies.
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V. P. Lupanov (2020) conducted a review in Chronic coronary syndromes and non-cardiovascular comorbidities. Guideline-directed management of chronic coronary syndromes was evaluated. The 2019 ESC Guidelines emphasize adapting anti-ischaemic treatment to individual patient comorbidities, co-administered therapies, and specific conditions like cancer, diabetes, and CKD.
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