Management of chronic coronary syndrome

Published on 26 March 2025

This ACE Clinical Guidance (ACG) provides evidence-based recommendations for managing patients with chronic coronary syndrome (CCS), with a focus on antiplatelet therapy and non-pharmacological interventions, including physical activity, smoking cessation, and dietary advice. Additionally, principles for assessing patients with CCS presenting with acute exacerbation of chest pain are outlined.

The ACG includes links to two patient education aids on coronary heart disease (CHD), and myths and facts about antiplatelet medicines for chronic CHD.

Download the ACG

Management of chronic coronary syndrome (Mar 2025) [PDF]

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ACG recommendations

1a.Use long-term low-dose aspirin monotherapy for secondary prevention of cardiovascular events.

1b.Consider long-term clopidogrel monotherapy as an alternative to aspirin.

2.Review patients following PCI to confirm that there is a specified treatment duration for their dual antiplatelet therapy and check with the referring cardiologist if treatment duration is unclear.

3a.For patients with new-onset AF with no recent stent (within the past 12 months), consider oral anticoagulant monotherapy based on modified CHA₂DS₂VASc score and patient factors such as comorbidities and bleeding risk. 

3b.For patients with new-onset AF and a stent within the past 12 months, consult a cardiologist to reassess and optimise the current antithrombotic therapy.

4.Optimise management of comorbid or associated conditions in patients with CCS to reduce overall cardiovascular risk and complications.

5.Encourage sustained lifestyle interventions, including regular physical activity tailored to the patient’s capabilities and preferences.

6.Schedule regular follow-up visits for all patients with CCS to monitor symptoms, assess medication adherence, and adjust treatment plans as needed.

Refer to the Evidence-to-Recommendation (EtR) framework below for a summary of the factors underpinning the ACG’s recommendations.

ACG references and EtR framework

Click below to see the list of references for the chronic coronary syndrome ACG.

Management of chronic coronary syndrome references (Mar 2025) [PDF]

The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the chronic coronary syndrome EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values.

Management of chronic coronary syndrome EtR framework (Mar 2025) [PDF]