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1. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

Author

Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thomas, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Leclercq C, Lewis BS, Merkely B, Mueller C, Petersen S, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thoma, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Clinical sciences, Cardio-vascular diseases, Cardiology, Knuuti, Juhani [0000-0003-3156-9593], Apollo - University of Cambridge Repository, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), University of Zurich, Knuuti, J., Wijns, W., Achenbach, S., Agewall, S., Barbato, E., Bax, J. J., Capodanno, D., Cuisset, T., Deaton, C., Dickstein, K., Edvardsen, T., Escaned, J., Funck-Brentano, C., Gersh, B. J., Gilard, M., Hasdai, D., Hatala, R., Mahfoud, F., Masip, J., Muneretto, C., Prescott, E., Saraste, A., Storey, R. F., Svitil, P., Valgimigli, M., Windecker, S., Aboyans, V., Baigent, C., Collet, J. -P., Dean, V., Delgado, V., Fitzsimons, D., Gale, C. P., Grobbee, D. E., Halvorsen, S., Hindricks, G., Iung, B., Juni, P., Katus, H. A., Landmesser, U., Leclercq, C., Lettino, M., Lewis, B. S., Merkely, B., Mueller, C., Petersen, S., Petronio, A. S., Richter, D. J., Roffi, M., Shlyakhto, E., Simpson, I. A., Sousa-Uva, M., Touyz, R. M., Benkhedda, S., Metzler, B., Sujayeva, V., Cosyns, B., Kusljugic, Z., Velchev, V., Panayi, G., Kala, P., Haahr-Pedersen, S. A., Kabil, H., Ainla, T., Kaukonen, T., Cayla, G., Pagava, Z., Woehrle, J., Kanakakis, J., Toth, K., Gudnason, T., Peace, A., Aronson, D., Riccio, C., Elezi, S., Mirrakhimov, E., Hansone, S., Sarkis, A., Babarskiene, R., Beissel, J., Cassar Maempel, A. J., Revenco, V., de Grooth, G. J., Pejkov, H., Juliebo, V., Lipiec, P., Santos, J., Chioncel, O., Duplyakov, D., Bertelli, L., Dikic, A. D., Studencan, M., Bunc, M., Alfonso, F., Back, M., Zellweger, M., Addad, F., Yildirir, A., Sirenko, Y., and Clapp, B.

Subjects
anti-ischaemic drug, chronic coronary syndromes, medicine.medical_treatment, [SDV]Life Sciences [q-bio], lipid-lowering drugs, Diagnostic Techniques, Cardiovascular, antithrombotic therapy, Disease, 030204 cardiovascular system & hematology, Guideline, Coronary artery disease, 0302 clinical medicine, Disease management (health), Societies, Medical, ComputingMilieux_MISCELLANEOUS, chronic coronary syndrome, angina pectori, Disease Management, food and beverages, imaging, risk assessment, Syndrome, 3. Good health, Natural history, Europe, Cardiology, Cardiology and Cardiovascular Medicine, coronary artery disease, medicine.medical_specialty, lifestyle modifications, anti-ischaemic drugs, Ischemia, 610 Medicine & health, vasospastic angina, Guidelines, Revascularization, diagnostic testing, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, angina pectoris, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Journal Article, Humans, business.industry, screening, fungi, 030229 sport sciences, medicine.disease, lipid-lowering drug, Angina pectoris, Anti-ischaemic drugs, Antithrombotic therapy, Chronic coronary syndromes, Diagnostic testing, Imaging, Lifestyle modifications, Lipid-lowering drugs, Microvascular angina, Myocardial ischaemia, Myocardial revascularization, Risk assessment, Screening, Vasospastic angina, myocardial ischaemia, myocardial revascularization, Heart failure, microvascular angina, Chronic Disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, lifestyle modification, Coronary Artery Disease/diagnosis, business, Fibrinolytic agent
Abstract

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

Published
2019

2. Acoustic-based rule out of stable coronary artery disease: the FILTER-SCAD trial.

Author

Bjerking LH, Skak-Hansen KW, Heitmann M, Hove JD, Haahr-Pedersen SA, Engblom H, Erlinge D, Räder SBEW, Brønnum-Schou J, Biering-Sørensen T, Kjærgaard CL, Strange S, Galatius S, and Prescott EIB

Abstract

Background and Aims: Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD) score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD score and PTP to cardiologists was superior to PTP alone in limiting testing., Methods: At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomised to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE)., Results: In total 2008 patients (46% male, median age 63 years) were randomised from October 2019 to September 2022. When randomised to CAD score (n=1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤5%, and 39.5% had CAD score ≤20. Testing was deferred in 22% with no differences in diagnostic tests between groups (p for superiority =0.56). In the PTP ≤5% subgroup, the proportion with deferred testing increased from 28% to 52% (p<0.001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.4% (95% CI -1.85 to 1.06) (p for non-inferiority = 0.005). No differences were seen in angina-related health status or quality of life., Conclusions: The implementation strategy of providing cardiologists with a CAD score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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3. Cost-effectiveness of adding a non-invasive acoustic rule-out test in the evaluation of patients with symptoms suggestive of coronary artery disease: rationale and design of the prospective, randomised, controlled, parallel-group multicenter FILTER-SCAD trial.

Author

Bjerking LH, Hansen KW, Biering-Sørensen T, Brønnum-Schou J, Engblom H, Erlinge D, Haahr-Pedersen SA, Heitmann M, Hove JD, Jensen MT, Kruse M, Räder S, Strange S, Galatius S, and Prescott EIB

Subjects
Acoustics, Coronary Angiography, Cost-Benefit Analysis, Humans, Prospective Studies, Quality of Life, Coronary Artery Disease diagnosis
Abstract

Introduction: Most patients with symptoms suggestive of chronic coronary syndrome (CCS) have no obstructive coronary artery disease (CAD) and better selection of patients to be referred for diagnostic tests is needed. The CAD-score is a non-invasive acoustic measure that, when added to pretest probability of CAD, has shown good rule-out capabilities. We aimed to test whether implementation of CAD-score in clinical practice reduces the use of diagnostic tests without increasing major adverse cardiac events (MACE) rates in patients with suspected CCS., Methods and Analysis: FILTER-SCAD is a randomised, controlled, multicenter trial aiming to include 2000 subjects aged ≥30 years without known CAD referred for outpatient assessment for symptoms suggestive of CCS. Subjects are randomised 1:1 to either the control group: standard diagnostic examination (SDE) according to the current guidelines, or the intervention group: SDE plus a CAD-score. The subjects are followed for 12 months for the primary endpoint of cumulative number of diagnostic tests and a safety endpoint (MACE). Angina symptoms, quality of life and risk factor modification will be assessed with questionnaires at baseline, 3 months and 12 months after randomisation. The study is powered to detect superiority in terms of a reduction of ≥15% in the primary endpoint between the two groups with a power of 80%, and non-inferiority on the secondary endpoint with a power of 90%. The significance level is 0.05. The non-inferiority margin is set to 1.5%. Randomisation began on October 2019. Follow-up is planned to be completed by December 2022., Ethics and Dissemination: This study has been approved by the Danish Medical Agency (2019024326), Danish National Committee on Health Research Ethics (H-19012579) and Swedish Ethical Review Authority (Dnr 2019-04252). All patients participating in the study will sign an informed consent. All study results will be attempted to be published as soon as possible., Trial Registration Number: NCT04121949; Pre-results., Competing Interests: Competing interests: LHB, KWH, JB-S, HE, SAH-P, MH, JDH, MK, MTJ, SR, SS, SG and EP: None. TB-S: Steering Committee member of the Amgen financed GALACTIC-HF trial; Advisory Board: Sanofi Pasteur; Advisory Board: Amgen; Speaker Honorarium: Novartis; Speaker Honorarium: Sanofi Pasteur; Research grant: GE Healthcare; Research grant: Sanofi Pasteur. DE: Advisory board for Acarix A/S., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2021
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