Editorial | DOI: https://doi.org/10.31579/2641-0419/028
1* Servergazi State Hospital, Cardiology, Bereketler No:1, 20000, Merkezefendi-Denizli Turkey
*Corresponding Author: Sara Cetin Sanlialp, MD, Servergazi State Hospital, Cardiology, Bereketler No:1, 20000, Merkezefendi-Denizli Turkey.
Citation: Sara Cetin Sanlialp (2019) Will Innovations in the 2019 ESC Guidelines for Chronic Coronary Syndromes Change the Approaches of Cardiologists?. J.Clinical Cardiologyand Cardiovascular Interventions, 2(2); Doi:10.31579/2641-0419/028
Copyright: © 2019 Sara Cetin Sanlialp. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 04 November 2019 | Accepted: 08 November 2019 | Published: 12 November 2019
Keywords: chronic coronary syndromes; cardiologists
Coronary heart diseases (CHD) and miyocardial enfarction are the most widespread diseases on the human population .
Coronary heart diseases (CHD) and miyocardial enfarction are the most widespread diseases on the human population [1]. Globally, CHD is the leading cause of morbidity and mortality in the world. Despite the reduction in the number of patients dying from this disease due to improvements in medical treatment and revascularization, unfortunately the number of individuals with CHD is rapidly increasing [2]. Cardiovascular diseases can be prevented by appropriate diet, education, abandonment of harmful habits and healty lifestyle. In addition, screening programs and risk reduction strategies can reduce the prevalence of CHD and can provide early detections for this [3]. For the reasons mentioned above, a new guideline was published in 2019 and we will talk about shortly the innovations that this guideline has brought.
In this guideline, the term stable coronary artery disease (CAD) has been omitted. This guideline has mentioned that coronary artery disease is a dynamic process, lifestyle changes and medical/ invasive treatments may stabilize this disease or it may result with acute events if the patients take inadequate theraphy and they have inappropriate lifestyle. According to this guideline, the patients may present 6 different scenarios to physicians: a) the patients who present with stable angina or dyspnoe b) patient with new onset of heart failure or left ventricular dysfunction c) patient with recent revascularization (<1> [4].
Which other innovations are there in this guideline? Among noninvasive tests, coronary CT-angiography and functional ischemic tests were prioritized and especially excercise ECG lost its popularity. Exercise ECG use is has been limited in this guideline. Excercise ECG has been recommended to evaluate only exercise intolerance, symptoms during exercise, arrhytmias, blood pressure response and event risk(in selected patients). Beta blockers have lost their importance on medical treatment. It has been specified that calcium channel blockers can be used for initial treatment instead of beta blockers. Cholesterol target levels have been lowered (LDL <50> [4].
Editorial comments:
Although the new guideline seems to provide convenience in diagnosis and treatment, it may cause to create disagreements among cardiologists. Rather than exercise ECG which is at hand of all cardiologists, the use of other methods can make them dependent on other branches that deal imaging methods. In addition, these tests cannot be performed in all clinics and impose financial burdens on countries may complicate to implement these recommendations every countries. Most of cardiologists will still seem to continue using of exercise ECG for diagnosis because of these reasons. Also, the habit of using betablokers prescribed for years may leave the physicians in the dilemma. Prolonged use of multiple antiplatelet agents may not be supported by physicians because of their anxiety about bleeding.
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