Giubilato Simona, Lucà Fabiana, Abrignani Maurizio Giuseppe, Gatto Laura, Rao Carmelo Massimiliano, Ingianni Nadia, Amico Francesco, Rossini Roberta, Caretta Giorgio, Cornara Stefano, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Pilleri Anna, Pozzi Andrea, Temporelli Pier Luigi, Zuin Marco, Amico Antonio Francesco, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo
Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy.
Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy.
J Clin Med. 2023 Sep 15;12(18):5989. doi: 10.3390/jcm12185989.
Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term "stable" with "chronic", as this disease is never truly "stable". Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.
慢性冠状动脉综合征（CCS）涵盖了冠状动脉疾病（CAD）的广泛临床表现，是全球发病和死亡的主要原因。近期的CCS管理指南强调了CAD进程的动态性质，用“慢性”取代了“稳定”一词，因为这种疾病从来都不是真正“稳定”的。尽管CAD治疗取得了重大进展，但由于所谓的残余心血管风险，CCS患者发生主要心血管事件（MACE）的风险仍然较高。几种致病途径（血栓形成、炎症、代谢和手术相关途径）可能在个体患者中对残余风险有不同程度的影响，并代表了新型预防性治疗的潜在靶点。识别残余心血管风险的水平和类型对于选择最合适的诊断测试和后续程序至关重要。此外，新的管理策略和医疗模式可以进一步支持现有治疗，并带来重要的预后益处。本综述旨在概述CCS患者管理中的诊断和治疗挑战，并促进更有效的多学科护理。
