2
Overview
Key Points
➤ Chronic coronary disease (CCD) is heterogeneous group of conditions
that includes obstructive and nonobstructive coronary artery
disease (CAD) with or without previous myocardial infarction (MI)
or revascularization, ischemic heart disease diagnosed only by
noninvasive testing, and chronic angina syndromes with varying
underlying causes and the risk of future cardiovascular (CV) events
is not uniform with symptom relief and improvement in quality of life
(QOL) important considerations.
• Approximately 20.1 million persons in the United States live with CCD.
• 11.1 million Americans have chronic stable angina pectoris, and approximately
one-quarter (n=200,000) of all MIs in the United States occur among the 8.8
million persons with CCD who have had a previous MI (Table 4).
• Despite an approximate 25% overall relative decline in death from coronary heart
disease (CHD) over the past decade, it remains the leading cause of death in the
United States and worldwide and is associated with substantial individual, economic,
and societal burdens. Within the United States (Figures 1 and 2; Table 4) and
worldwide (Figure 3), the prevalence of CCD and chronic stable angina vary by age,
sex, race, ethnicity, and geographic region, and the role of social determinants of health
(SDOH) in both risk for and outcomes from CCD is increasingly recognized.
➤ The number and complexity of comorbid conditions and concurrent
treatments for those conditions among patients with CCD have increased.
➤ Thus, this guideline will address established diagnostic, risk
stratification, and treatment approaches in a contemporary context,
new therapies, and the intersection between CCD and other comorbid
diseases in a framework that recognizes the importance of shared
decision-making, team-based care, and cost and value.
CCD Definition
➤ This guideline is intended to apply to the following categories of
patients in the outpatient setting:
• Patients discharged after admission for an acute coronary syndrome (ACS) event
or after coronary revascularization procedure and after stabilization of all acute
cardiovascular issues.
• Patients with left ventricular (LV) systolic dysfunction and known or suspected
coronary artery disease (CAD) or those with established cardiomyopathy deemed
to be of ischemic origin.
• Patients with stable angina symptoms (or ischemic equivalents such as dyspnea or
arm pain with exertion) medically managed with or without positive results of an
imaging test.
• Patients with angina symptoms and evidence of coronary vasospasm or
microvascular angina.
• Patients diagnosed with CCD based solely on the results of a screening study
(stress test, coronary computed tomography angiography [CTA]), and the treating
clinician concludes that the patient has coronary disease.
