Angina Pectoris: Classification

Canadian Cardiovascular Society (CCS): staging of stable angina pectoris.

CCS stage Definition
0 Silent ischemia (reduced blood flow) without any symptoms (= no restriction of physical activity)Angina pectoris only during severe, rapid or sustained exertion
I Symptomatology only with severe physical exertion (= mild limitation of physical activity)Angina pectoris when walking or climbing stairs at increased speed or after meals,walking more than 100 m or climbing stairs more than 1 floor at normal speedwalking uphill, cold, emotional stress
II Minor discomfort with normal physical activity (= marked limitation of physical activity)Angina pectoris on walking less than 100 m or after climbing stairs of 1 floor at a normal rate
III Angina pectoris even with mild physical exertion or already at rest
IV Angina pectoris on any physical exertion or already at rest

Classification of unstable angina (UA)

Severity Clinical situation
Class A Class B Class C
Class I: new-onset severe or worsening angina pectoris (AP), no resting AP. IA IB IC
Class II: resting AP in the past month but not in the past 48 h (subacute AP). IIA IIB IIC
Class III: resting AP within the past 48 h (acute resting AP). IIIA IIIC

Legend

  • Class A: patients with extracardiac (outside the heart cause/secondary angina, AP).
  • Class B: patients without an extracardiac cause (primary unstable AP).
  • Class C: patients 2 weeks after myocardial infarction/heart attack (postinfarction AP).