2026 Focused Update of the Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes.
11 affiliations
- 1Department of Cardiology, Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia.
- 2Department of Adult Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia.
- 3Department of Cardiology, Seha Virtual Hospital, Ministry of Health, Riyadh, Saudi Arabia.
- 4Catheterization Laboratory, Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
- 5Department of Cardiology, Dr. Sulaiman Al-Habib Hospital, Al-Khobar, Saudi Arabia.
- 6Department of Cardiac Sciences, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia.
- 7Department of Medicine, College of Medicine, Umm AlQura University, Makkah, Saudi Arabia.
- 8Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
- 9Department of Cardiac Surgery, National Heart Center, Saudi Health Council, Riyadh, Saudi Arabia.
- 10Department of Cardiology, Armed Forces Hospitals Southern Region, Saudi Arabia.
- 11Administration, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.
Abstract
Background
Chronic coronary syndromes (CCS) continue to impose a substantial clinical and economic burden in Saudi Arabia. Since publication of the 2022 Saudi Heart Association (SHA) CCS guidelines, important advances have emerged in diagnosis, pharmacotherapy, cardiometabolic risk reduction, antiplatelet management, and revascularization. This 2026 focused update selectively revises and clarifies key recommendations to reflect these advances within the Saudi context.Methods
A multidisciplinary SHA expert panel conducted a structured review of randomized trials, meta-analyses, and relevant international guidance published since 2022. Updates were restricted to areas with substantive new evidence or evolving clinical practice. Recommendations were formulated through expert consensus in accordance with SHA methodological standards. This document complements the 2022 guideline and does not replace it.Results and conclusions
This focused update advances a more personalized, risk-driven approach to CCS management. Diagnostic algorithms now explicitly integrate pre-test probability, reinforce coronary computed tomography angiography as the preferred initial modality in low-to-intermediate probability, and refine the positioning of functional stress imaging. Residual risk assessment and preventive strategies are also strengthened. Importantly, this update introduces a dedicated diagnostic and management framework for angina and ischemia with non-obstructive coronary arteries (ANOCA/INOCA), emphasizing endotype-specific evaluation and targeted therapy for this historically under-recognized population. Anti-anginal therapy positions beta-blockers and calcium channel blockers as equivalent first-line agents, upgrades long-acting nitrates, and integrates ranolazine, ivabradine, and trimetazidine as evidence-based add-on options. Antiplatelet guidance emphasizes individualized dual antiplatelet therapy duration after percutaneous coronary intervention (PCI), early de-escalation strategies, and selective use of P2Y12 inhibitor monotherapy. Lipid management and cardiovascular risk reduction options are now expanded and revascularization recommendations are restructured. Collectively, these updates strengthen the delivery of contemporary, evidence-based, and patient-centered CCS care and provide a clear framework for implementation across diverse healthcare settings.
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BibTeX
@article{alshammeri20262026,
title = {{2026 Focused Update of the Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes.}},
author = {Owayed Alshammeri and Halia Alshehri and Shukri Alsaif and Mirvat Alasnag and Fatema Qaddoura and Fahad Alqahtani and Yosra A A Turkistani and Walid Alharbi and Adel Tash and Mohammad Alshehri and Khalid Al Faraidy and Waleed Alhabeeb},
journal = {Journal of the Saudi Heart Association},
year = {2026},
month = aug,
doi = {10.37616/2212-5043.1516},
url = {https://europepmc.org/article/MED/42910058},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 2026 Focused Update of the Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes.
AU - Owayed Alshammeri
AU - Halia Alshehri
AU - Shukri Alsaif
AU - Mirvat Alasnag
AU - Fatema Qaddoura
AU - Fahad Alqahtani
AU - Yosra A A Turkistani
AU - Walid Alharbi
AU - Adel Tash
AU - Mohammad Alshehri
AU - Khalid Al Faraidy
AU - Waleed Alhabeeb
PY - 2026
DA - 2026/08/18
JO - Journal of the Saudi Heart Association
DO - 10.37616/2212-5043.1516
UR - https://europepmc.org/article/MED/42910058
AB - Background Chronic coronary syndromes (CCS) continue to impose a substantial clinical and economic burden in Saudi Arabia. Since publication of the 2022 Saudi Heart Association (SHA) CCS guidelines, important advances have emerged in diagnosis, pharmacotherapy, cardiometabolic risk reduction, antiplatelet management, and revascularization. This 2026 focused update selectively revises and clarifies key recommendations to reflect these advances within the Saudi context.Methods A multidisciplinary SHA expert panel conducted a structured review of randomized trials, meta-analyses, and relevant international guidance published since 2022. Updates were restricted to areas with substantive new evidence or evolving clinical practice. Recommendations were formulated through expert consensus in accordance with SHA methodological standards. This document complements the 2022 guideline and does not replace it.Results and conclusions This focused update advances a more personalized, risk-driven approach to CCS management. Diagnostic algorithms now explicitly integrate pre-test probability, reinforce coronary computed tomography angiography as the preferred initial modality in low-to-intermediate probability, and refine the positioning of functional stress imaging. Residual risk assessment and preventive strategies are also strengthened. Importantly, this update introduces a dedicated diagnostic and management framework for angina and ischemia with non-obstructive coronary arteries (ANOCA/INOCA), emphasizing endotype-specific evaluation and targeted therapy for this historically under-recognized population. Anti-anginal therapy positions beta-blockers and calcium channel blockers as equivalent first-line agents, upgrades long-acting nitrates, and integrates ranolazine, ivabradine, and trimetazidine as evidence-based add-on options. Antiplatelet guidance emphasizes individualized dual antiplatelet therapy duration after percutaneous coronary intervention (PCI), early de-escalation strategies, and selective use of P2Y12 inhibitor monotherapy. Lipid management and cardiovascular risk reduction options are now expanded and revascularization recommendations are restructured. Collectively, these updates strengthen the delivery of contemporary, evidence-based, and patient-centered CCS care and provide a clear framework for implementation across diverse healthcare settings.
SN - 1016-7315
SN - 2212-5043
ER -