Article

In 2013 the European Society of Cardiology (ESC) released new guidelines on the
management of stable coronary artery disease. These guidelines update and replace
the previous ESC guidelines on the management of stable angina pectoris, issued
in 2006. There are several new aspects in the 2013 ESC guidelines compared with
the 2006 version. This opinion paper provides an in-depth interpretation of the
ESC guidelines with regard to these issues, to help physicians in making
evidence-based therapeutic choices in their routine clinical practice. The first
new element is the definition of stable coronary artery disease itself, which has
now broadened from a 'simple' symptom, angina pectoris, to a more complex disease
that can even be asymptomatic. In the first-line setting, the major changes in
the new guidelines are the upgrading of calcium channel blockers, the distinction
between dihydropyridines and non-dihydropyridine calcium channel blockers, and
the presence of important statements regarding the combination of calcium channel
blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines
recommend the addition of long-acting nitrates, ivabradine, nicorandil or
ranolazine to first-line agents. Trimetazidine may also be considered. However,
no clear distinction is made among different second-line drugs, despite different
quality of evidence in favour of these agents. For example,
the use of ranolazine
is supported by strong and recent evidence, while data supporting the use of the
traditional agents appear relatively scanty.
CI - (c) The European Society of Cardiology 2016.

Langue : ANGLAIS