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Review
. 2023 Sep 15;12(18):5989.
doi: 10.3390/jcm12185989.

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

Simona Giubilato  1 , Fabiana Lucà  2 , Maurizio Giuseppe Abrignani  3 , Laura Gatto  4 , Carmelo Massimiliano Rao  2 , Nadia Ingianni  5 , Francesco Amico  1 , Roberta Rossini  6 , Giorgio Caretta  7 , Stefano Cornara  8 , Irene Di Matteo  9 , Concetta Di Nora  10 , Silvia Favilli  11 , Anna Pilleri  12 , Andrea Pozzi  13 , Pier Luigi Temporelli  14 , Marco Zuin  15   16 , Antonio Francesco Amico  17 , Carmine Riccio  18 , Massimo Grimaldi  19 , Furio Colivicchi  20 , Fabrizio Oliva  9 , Michele Massimo Gulizia  21   22
Affiliations
Review

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

Simona Giubilato et al. J Clin Med. .

Abstract

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.

Keywords: angina; chronic coronary syndromes; multidisciplinary management; optimal medical therapy; percutaneous coronary intervention; residual cardiovascular risk; secondary prevention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pathways of residual CV risk, scientific evidence, and potential targeting interventions.
Figure 2
Figure 2
Model for the management of CCS patients. Modified from Knuuti J et al., EHJ 2020 [1]. * Time for decision-making on DAPT/SAPT in post-PCI patients; ** time for decision-making on long term antithrombotic therapy according clinical and procedural residual ischemic risk; † at any time to investigate changes in symptoms and/or functional status; invasive coronary angiography only for patients with symptoms despite OMT or with moderate/severe ischemia on non-invasive stress tests. ° In pts with previous abnormal rest echo. CV: cardiovascular; ECG: electrocardiogram; Echo: echocardiography.
See this image and copyright information in PMC

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