Chronic Coronary Syndromes (CCS) remain a major health burden globally. A decline in mortality from acute events has been observed but many patients progress to develop ischaemic heart failure. In the future, there will be an increase in chronic manifestations of CCS such as stable angina, due to the aging population and the obesity and diabetes epidemics.
Chronic stable angina in its various clinical presentations can be caused by obstruction of large epicardial arteries or by non-obstructive mechanisms including coronary epicardial spasm and coronary microvascular dysfunction. This dysfunction can be caused by both functional and structural alterations. Obstructive coronary artery disease, coronary spasm and coronary microvascular dysfunction can coexist in the same patients. This is why angina can persist after successful coronary revascularization in many patients.
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