[ESC guidelines 2019 on chronic coronary syndrome (CCS, previously "stable coronary artery disease") : What is new? What is particularly important?]

After an unusually long period of time of 6 years, in August 2019 the updated version of the European Society of Cardiology (ESC) guidelines from 2013 on the management of stable coronary artery disease was published. The course of "stable" coronary artery disease is only assumed to be stable and pathologically is often progressive but initially goes unnoticed. In order to raise awareness for the progressive character of "stable" coronary artery disease, the term chronic coronary syndrome (CCS) was introduced. In this overview the various phenotypes of CCS are divided into three groups. 1) Suspected obstructive coronary artery disease: the emphasis here is on functional, noninvasive imaging diagnostics of ischemia and cardiac computed tomography (CT). These diagnostic options have become even more important in the light of the decreasing prevalence of coronary artery disease. 2) Known obstructive coronary artery disease: here there are many new practice-relevant recommendations, particularly in the field of pharmaceutical treatment with antithrombotic drugs. 3) Microvascular disease: in symptomatic patients the exclusion of epicardial coronary stenoses using invasive coronary angiography should not signify the end of the diagnostic procedure. Functional tests in the catheter laboratory should be initiated in order not to overlook a microvascular cause of the complaints and do an injustice to the patient.