Navigating medical management in chronic coronary syndrome: evidence, controversies and guideline updates

Abstract Chronic coronary syndrome (CCS), one of the top contributors to mortality and morbidity worldwide, is an emerging entity that moves beyond the traditional view of fixed, flow-limiting epicardial stenoses as the sole cause of ischaemia to encompass a broader and more heterogeneous group of conditions. This heterogeneity underscores the importance of individualised management, guided by an assessment of each patient’s future cardiovascular risk. Despite recent international guidelines for the management of CCS, significant gaps and controversies remain. Our review, with a focus on the Asia-Pacific population, aims to highlight key updates from the latest international guidelines and explore potential directions for addressing these persistent challenges in CCS care.