ESC 2024 Guidelines — Chronic Coronary Syndromes

The 2024 guideline replaces the 2019 text and rewrites the diagnostic pathway. The pre-test likelihood model has been revised downward again, which changes who needs testing at all, and coronary CT angiography has moved further to the front for patients in the lower likelihood bands.

Exam questions cluster where the pathway forks. Which first-line test for which patient — and, just as often, which test is wrong: CCTA in heavy calcification, an exercise ECG where imaging is indicated, invasive angiography without a functional question to answer. Then the therapeutic side: antianginal selection, when a pressure wire is indicated and when routine wire-based assessment of every vessel is not, and how revascularisation decisions are made in stable disease.

The overlap with the acute coronary syndrome guideline is deliberate on the ESC's part and worth practising together. Several antithrombotic recommendations are phrased almost identically in both documents, and knowing which one governs a given patient is itself an exam point.