2013 ESC Guidelines on the Management of Stable Coronary Artery Disease

The Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology

Gilles Montalescot (Chairperson) (France); Udo Sechtem (Chairperson) (Germany); Stephan Achenbach (Germany); Felicita Andreotti (Italy); Chris Arden (UK); Andrzej Budaj (Poland); Raffaele Bugiardini (Italy); Filippo Crea (Italy); Thomas Cuisset (France); Carlo Di Mario (UK); J. Rafael Ferreira (Portugal); Bernard J. Gersh (USA); Anselm K. Gitt (Germany); Jean-Sebastien Hulot (France); Nikolaus Marx (Germany); Lionel H. Opie (South Africa); Matthias Pfisterer (Switzerland); Eva Prescott (Denmark); Frank Ruschitzka (Switzerland); Manel Sabaté (Spain); Roxy Senior (UK); David Paul Taggart (UK); Ernst E. van derWall (Netherlands); Christiaan J.M. Vrints (Belgium); Jose Luis Zamorano (Chairperson) (Spain); Stephan Achenbach (Germany); Helmut Baumgartner (Germany); Jeroen J. Bax (Netherlands); Héctor Bueno (Spain); Veronica Dean (France); Christi Deaton (UK); Cetin Erol (Turkey); Robert Fagard (Belgium); Roberto Ferrari (Italy); David Hasdai (Israel); ArnoW.Hoes (Netherlands); Paulus Kirchhof (Germany/UK); JuhaniKnuuti (Finland); Philippe Kolh (Belgium); Patrizio Lancellotti (Belgium); Ales Linhart (CzechRepublic); Petros Nihoyannopoulos (UK); Massimo F. Piepoli (Italy); Piotr Ponikowski (Poland); Per Anton Sirnes (Norway); Juan Luis Tamargo (Spain); Michal Tendera (Poland); AdamTorbicki (Poland); WilliamWijns (Belgium); StephanWindecker (Switzerland); Juhani Knuuti (CPG Review Coordinator) (Finland); Marco Valgimigli (Review Coordinator) (Italy); Héctor Bueno (Spain); Marc J. Claeys (Belgium); Norbert Donner-Banzhoff (Germany); Cetin Erol (Turkey); Herbert Frank (Austria); Christian Funck-Brentano (France); Oliver Gaemperli (Switzerland); José R. Gonzalez-Juanatey (Spain); Michalis Hamilos (Greece); David Hasdai (Israel); Steen Husted (Denmark); Stefan K. James (Sweden); Kari Kervinen (Finland); Philippe Kolh (Belgium); Steen Dalby Kristensen (Denmark); Patrizio Lancellotti (Belgium); Aldo Pietro Maggioni (Italy); Massimo F. Piepoli (Italy); Axel R. Pries (Germany); Francesco Romeo (Italy); Lars Rydén (Sweden); Maarten L. Simoons (Netherlands); Per Anton Sirnes (Norway); Ph. Gabriel Steg (France); Adam Timmis (UK); William Wijns (Belgium); StephanWindecker (Switzerland); Aylin Yildirir (Turkey); Jose Luis Zamorano (Spain).


Eur Heart J. 2013;34(38):2949-3003. 

In This Article

1. Preamble

Guidelines summarize and evaluate all evidence available, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are not substitutes but are complements for textbooks, and cover the ESC Core Curriculum topics. Guidelines and recommendations should help physicians to make decisions in their daily practice: however, the final decisions concerning an individual patient must be made by the responsible physician(s).
A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for the diagnosis, management and/or prevention of a given condition according to the ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to predefined scales, as outlined in Table 1 and Table 2 .

The experts of the writing and reviewing panels completed Declaration of Interest forms where real or potential sources of conflicts of interest might be perceived. These forms were compiled into one file and can be found on the ESC website (http://www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period must be notified to the ESC and updated. The Task Force received its entire financial support from the ESC, without any involvement from healthcare industry.

The ESC CPG supervises and co-ordinates the preparation of new Guidelines produced by Task Forces, expert groups or consensus panels. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts. After appropriate revisions, they are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal.

The task of developing ESC Guidelines covers not only the integration of the most recent research, but also the creation of educational tools and implementation programmes for the recommendations. To implement the guidelines, condensed pocket editions, summary slides, booklets with essential messages, electronic versions for digital applications (smartphones etc.) are produced. These versions are abridged and thus, if needed, one should always refer to the full text version, which is freely available on the ESC website. The National Societies of the ESC are encouraged to endorse, translate and implement the ESC Guidelines. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.

Surveys and registries are needed to verify that real-life daily practice is in keeping with what is recommended in the guidelines, thus completing the loop between clinical research, writing of guidelines and implementing them into clinical practice.

The Guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with that patient and, where appropriate and necessary, the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.