Chronic coronary syndromes - guideline changes and a new nomenclature

Our understanding of the pathogenesis, clinical presentation, diagnosis, and management of angina pectoris has evolved substantially over the past few decades. Newer international guidelines have recently been published that provide recommendations for the diagnosis and management of ischaemic syndromes which are aligned with the advances in the pathogenesis of ischaemic myocardial syndromes. In parallel to those very welcome updates of the European guidelines I argue in this manuscript that nomenclature changes are required to better reflect the large spectrum of phenotypes and clinical presentations that come to our attention in clinical practice and currently grouped under the term chronic coronary syndromes. The latter term does not truly reflect the important contribution that non-obstructive coronary causes and non- vascular causes of both myocardial ischaemia and myocardial infarction make to the pathogenesis of ischaemic heart syndromes. This manuscript represents a viewpoint about the need for a more comprehensive and accurate nomenclature that helps clinicians to plan stratified treatments based on specific pathogenic mechanisms rather than focusing on epicardial coronary artery obs- tructions as the key mechanism underlying myocardial ischaemia.