Extract
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In patients with chest pain of cardiac origin, the underlying cause has been described as coronary artery disease (CAD1), ischaemic heart disease, or microvascular disease,2 among other conditions. The new concept of ‘chronic coronary syndromes’ noted in the 2019 ESC Guidelines3 that are part of this issue tries to cover this wide spectrum and changing natural history of the disease involving different parts of the coronary circulation, different mechanisms such as plaques4 or spasm,5 and/or episodes of ischaemia, or even infarction followed by stable periods, respectively.
Over the last decades, the profile of chronic coronary syndrome has changed substantially. In a FAST TRACK entitled ‘Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry’, Kim M. Fox from the National Heart and Lung Institute in London, UK and colleagues determined current characteristics and management of 32 703 patients with chronic coronary syndrome over 5 years of follow-up.6 The primary outcome of cardiovascular (CV) death or myocardial infarction was 8.0%. Independent predictors were prior hospitalzation for heart failure, current smoking, atrial fibrillation, living in Central or South America, prior myocardial infarction or stroke, diabetes, current angina, and peripheral artery disease. In those with prior myocardial infarction, angina was associated with a higher event rate of 11.8% vs. 8.2% in those without it (Figure 1). Of note, in patients without prior myocardial infarction, event rates were similar with or without angina. Prescription rates of evidence-based secondary prevention therapies were high. Thus, despite high rates of prescription of evidence-based therapies, patients with both angina and prior myocardial infarction are a high-risk group who may deserve intensive treatment. These clinically most important findings are put into context in an Editorial by Udo Sechtem and colleagues from the Robert Bosch Krankenhaus in Stuttgart, Germany.7
