Chronic Coronary Syndrome: When Should We Decide to Choose Invasive Strategy

A. Sunarya Soerianata, MD

Chronic coronary syndrome (CCS) is a stable clinical presentation of coronary artery

disease (CAD), a pathological process characterized by atherosclerotic plaque accumulation in
the epicardial arteries, whether obstructive or non-obstructive. The clinical scenarios encountered
in CCS patients are various, from classic anginal symptoms and/or dyspnoea; new onset of heart
failure or left ventricular dysfunctions; asymptomatic and symptomatic patients with stabilized
symptoms <1 year and >1 years after ACS/revascularization; vasospastic or microvascular
disease; and asymptomatic subjects in whom CAD is detected at screening. The goals of therapy
in CCS are to alleviate symptoms and decrease the risk of adverse cardiovascular outcomes such
as death, heart failure, or myocardial infarction. Clinical trials have promoted the use of medical
therapy as first-line management for CCS. Invasive strategy for revascularization, should remain
a therapeutic choice restricted to certain subgroups of CCS patients. The principal indications for
invasive strategy in CCS are symptom relief in case of angina despite optimal medical therapy
and prognosis improvement by lowering cardiovascular events. In patients being considered for
coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary
Heart Team approach is recommended. Treatment decisions should be patient centered,
incorporate patient preferences and goals, and include shared decision-making considering to
patient preference.

Keywords: angina; chronic coronary; invasive; revascularization