Canadian Cardiovascular Society grading of angina pectoris

The Canadian Cardiovascular Society grading of angina pectoris (sometimes referred to as the CCS Angina Grading Scale or the CCS Functional Classification of Angina) is a classification system used to grade the severity of exertional angina.

The CCS grading system for angina is a clinical tool used by doctors to assess the degree of severity of a patient's angina. Whilst there are no defined therapy guidelines specific for each class, once the severity of the angina has been assessed, clinicians can use the framework to aid them in the development of an individual treatment plan. This will also depend on unique patient factors, such as age, and risk of major cardiac complications.

In low severity cases, treatment will primarily consist of lifestyle changes, such as exercise, change in diet, smoking cessation. Often, this will be supplemented with medication.

For higher severity cases, this medication may need to be combined with surgery. For example percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Both PCI and CABG are effective at minimising symptoms and preventing progression of the disorder. However, each therapy has its advantages and disadvantages when it comes to individual patient profile. PCI is one of the most commonly performed procedures on the heart. It is non-invasive, and so can be carried out safely in most patient groups. In high-risk patients, such as those over the age of 65, with diabetes, or with multi-vessel disorder, CABG is a preferential technique. Although it is more invasive, in this group of patients, CABG has a higher long-term survival rate compared to PCI.

The CCS grading system is widely adopted in medical literature, with 656 manuscripts citing this grading system as of 2002 (87% were written in English, 28% in German, 27% in Russian, 22% in French, 2% each in Scandinavian and Spanish, and 1% in Japanese). The CCS grading system has also been described in at least 18 medical and nursing textbooks. Increasing CCSA class was associated with increased long-term mortality, even after adjusting for baseline characteristics (P<0.01). Eight-year mortality rates were 20.5%, 24.1%, 40.4% and 35.3% among class I, II, III and IV patients, respectively. Limitations of the CCS grading system include the lack of consideration of confounding factors, such as drug therapy before exertion (particularly sublingual nitrates),and personal warm-up.

The CCS grading system for angina is, in part, used to evaluate fitness to fly by the British Cardiovascular Society. They recommend no action by class I and II patients with stable angina, class III should consider mobility assistance from airport staff and in-flight supplemental oxygen therapy, and that class IV patients should ideally defer their travel plans or travel with a medical chaperone and use supplemental oxygen in-flight.

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