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Asian Biomed (Res Rev News)
Asian Biomed (Res Rev News)
abm
abm
Asian Biomedicine: Research, Reviews and News
1905-7415
1875-855X
Sciendo

abm-2024-0020
10.2478/abm-2024-0020
Editorial
Prediction of the severity of patients with chronic coronary syndrome
Editorial Office of Asian Biomedicineabmjournal@chula.ac.th

Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
20 9 2024
8 2024
18 4 146147
© 2024 Editorial Office of Asian Biomedicine, published by Sciendo
2024
Editorial Office of Asian Biomedicine, published by Sciendo
https://creativecommons.org/licenses/by/4.0/ This work is licensed under the Creative Commons Attribution 4.0 International License.
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pmcThe goals in the care of patients with chronic coronary syndrome (CCS) are to secure the diagnosis, assess the extent of disease, relieve symptoms, and prevent future cardiac events such as acute coronary syndromes, revascularization, or death [1]. The presence of left main coronary artery disease (LMCAD) and the occurrence of triple-vessel diseases (TVDs) are significant indicators for the need of proper intervention [2].

The currently recommended first-line diagnostic tests for CCS include coronary computed tomographic angiography. Since the test may not be readily available in resource-poor settings, this recommendation is not mandatory [3]. Exercise stress testing and electrocardiography should be undertaken in all patients to document the presence and extent of coronary disease.

Magnetic resonance imaging would be required for some selected patients with possible ischemic heart disease to assess the conditions of coronary arteries, the status of left ventricular function, and the potential needs for revascularization [4].

Anginal symptoms can be prevented by either beta blockers, calcium channel blockers, or long-acting nitrates, which can be used singly or in combination, depending on the ability to immediately relieve the symptoms and side effects [1, 5]. In addition, other measures such as improving lifestyle factors are needed to reduce the chances of disease progression. Cognitive behavioral interventions can be beneficial to help individuals achieve a healthy lifestyle. Exercise-based cardiac rehabilitation may be effective in assisting patients for controlling risks. A multidisciplinary health care team may be assembled to help patients accomplish desirable outcomes. The members in the team may include cardiologists, general practitioners, nurses, dietician, physiotherapists, psychologists, pharmacists, etc [5]. Influenza vaccination can reduce the possibility of hospitalization in these patients. Periodic follow-up is crucial to assess the stability of patients’ conditions. New onset of heart failure or left ventricular systolic dysfunction (LVSD) may be an early sign of significant LMCAD, which is associated with the need for prompt interventions [6]. Influenza vaccination can reduce hospitalization for coronary syndrome in elderly patients with chronic obstructive pulmonary disease [7].

Nuchanat and Methavigul in this issue reported a predictive model for LMCAD or TVD in patients with CCS [8]. According to their prediction score, patients with CCS who developed new onset of heart failure or LVSD and suspected CAD, ST elevation in aVR, ST elevation in V1, and lateral ST depression were associated with increased risk of LMCAD/TVD and needed prompt appropriate intervention. The novel prediction score could predict LMCAD/TVD in those patients with acceptable sensitivity, specificity, PPV, and NPV. The generation of the score only requires the patients’ symptoms of LVSD and electrocardiography. This can be advantageous to design further strategies to save lives.

The prediction score should be further evaluated in larger samples to establish its benefit in various clinical settings to document the utility of the clinical score.
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References

[1] Virani SS Newby LK Arnold SV Bittner V Brewer LC Demeter SH 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines Circulation 2023 148 e9 119 37471501
[2] Chiarito M Mehilli J Left main coronary artery disease: when and how to perform PCI? Minerva Cardioangiol 2020 68 405 14 32107900
[3] Ueng KC Chiang CE Chao TH Wu YW Lee WL Li YH 2023 Guidelines of the Taiwan Society of Cardiology on the diagnosis and management of chronic coronary syndrome Acta Cardiol Sin 2023 39 4 96 36685161
[4] Ricci F Khanji MY Bisaccia G Cipriani A Di Cesare A Ceriello L Diagnostic and prognostic value of stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis JAMA Cardiol 2023 8 662 73 37285143
[5] Fihn SD Gardin JM Abrams J Berra K Blankenship JC Dallas AP 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation 2012 126 e354 471 23166211
[6] Parma Z Jasilek A Greenlaw N Ferrari R Ford I Fox K Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry Eur J Heart Fail 2020 22 804 12 32297414
[7] Sung LC Chen CI Fang YA Lai CH Hsu YP Cheng TH Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study Vaccine 2014 32 3843 9 24837769
[8] Nuchanat P Methavigul K Predictive model for left main coronary artery or triple vessel disease in patients with chronic coronary syndromes Asian Biomed (Res Rev News) 2024 18 180 185
