The 2024 ESC Guidelines on chronic coronary syndromes (CCS) prioritize a a patient-centered approach to diagnosis and management, emphasizing personalized strategies, shared decision-making and promoting adherence to therapy. 

Key highlights:

• Updated CCS definition: Moves beyond the traditional focus on obstructive coronary artery disease to emcompass broader pathophysiological mechanisms, including microvascular dysfunction¹

• Emphasis on ANOCA/INOCA: Provides specific guidance for diagnosing and managing patients with angina/ischemia in the absence of coronary artery disease (CAD)¹

• Streamlined diagnostic pathway: A four-step process, from initial assessment to advanced imaging, faciliates efficient and targeted evaluation¹

• Improved risk stratification: Refined risk models help identify patients at very low risk of obstructive CAD, potentially reducing unnecessary testing¹

• Advanced diagnostics: Coronary computed tomography angiography (CCTA) and functional testing like stress echocardiography or cardiac magnetic resonance imaging are recommended for accurate diagnosis and guiding revascularization decisions¹

• Holistic approach to risk factor management: With a focus on achieving an LDL-C target of <55 mg/dL through a stepwise strategy: initiating high-intensity statins, adding ezetimibe, and considering PCSK9 inhibitors when necessary¹

The 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases (PAAD) present a comprehensive, patient-centred approach to diagnosis and treatment. These guidelines integrate recommendations for both peripheral arterial and aortic conditions, reflecting the interconnected nature of the arterial system. 

Key highlights:

• Early screening and diagnosis: Emphasizes early detection of PAAD through non-invasive vascular tests and imaging such as duplex ultrasound, including revised abdominal aortic aneurysm (AAA) screening criteria²

• Multidisciplinary care: Reinforces the importance of a team-based approach to managing PAAD, ensuring that patients recieve coordinated care across various specialties²

• SMART risk score: Introduces a new tool for cardiovascular risk prediction and personalized treatment²

• Intensive risk factor modification: Highlights lifestyle modifications (smoking cessation, healthy diet, regular physical activity) and achieving blood pressure and LDL-C targets (goal of <55 mg/dL and a reduction of at least 50% from baseline)²

• Updated treated algorithms: Provides new guidance on revascularization for acute mesenteric ischemia, aortic aneurysm management, and treatment of type B intramural hematoma and penetrating atherosclerotic ulcers²

• Thoracic aortic imaging and bicuspid aortic valve: Offers updated recommendations for imaging and surveillance²