RT Book, Section A1 Bangalore, Sripal A1 Ali, Ziad A1 Narula, Jagat A1 Puskas, John A1 Stone, Gregg W. A2 Fuster, Valentin A2 Narula, Jagat A2 Vaishnava, Prashant A2 Leon, Martin B. A2 Callans, David J. A2 Rumsfeld, John A2 Poppas, Athena SR Print(0) ID 1191371958 T1 Chronic Coronary Syndromes T2 Fuster and Hurst's The Heart, 15e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264257560 LK accesscardiology.mhmedical.com/content.aspx?aid=1191371958 RD 2023/02/07 AB Chapter SummaryThis chapter reviews the epidemiology, diagnosis, and management of chronic coronary syndromes (see Fuster & Hurst’s Central Illustration). Assessment of pretest probability of coronary artery disease (CAD) aids in appropriate risk stratification of patients with suspected chronic coronary syndromes. The Duke, updated Diamond–Forrester, and CORSCORE risk models are the most accurate in predicting CAD. The ischemic cascade is based on progressive mismatch between coronary blood flow and myocardial oxygen demand and, since perfusion defects occur earlier than do wall motion abnormalities, tests that rely on detection of perfusion defects (such as SPECT) are more sensitive than those that detect wall motion abnormalities (such as stress echocardiography), which are more specific for the detection of obstructive CAD. Detection of CAD by coronary computed tomography angiography is associated with a reduced incidence of myocardial infarction. Goal-directed medical therapy consists of intensive and comprehensive secondary prevention and includes lifestyle and pharmacological approaches. Patients with refractory symptoms despite goal-directed medical therapy, and/or elevated clinical or angiographic risk profiles and suitable coronary anatomy, may benefit from revascularization. Coronary artery anatomy, left ventricular systolic function, systemic factors (eg, diabetes), and patient values and preferences should be considered when choosing the revascularization strategy (ie, percutaneous coronary intervention versus coronary artery bypass graft surgery).