Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing


 * Associate Editors-in-Chief: ; Smita Kohli, M.D.

==ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT) == {{cquote|

Class IIb
1. Exercise ECG testing without an imaging modality in asymptomatic patients with possible myocardial ischemia on ambulatory ECG (AECG) monitoring or with severe coronary calcification on EBCT in the absence of one of the following ECG abnormalities:


 * a. Preexcitation (Wolff-Parkinson-White syndrome) (Level of Evidence: C)


 * b. Electronically paced ventricular rhythm (Level of Evidence: C)


 * c. More than 1 mm of ST depression at rest (Level of Evidence: C)


 * d. Complete left bundle-branch block. (Level of Evidence: C)

2. Exercise perfusion imaging or exercise echocardiography in asymptomatic patients with possible myocardial ischemia on ambulatory ECG monitoring or with severe coronary calcification on EBCT who are able to exercise and have one of the following baseline ECG abnormalities:


 * a. Preexcitation (Wolff-Parkinson-White syndrome) (Level of Evidence: C)


 * b. More than 1 mm of ST depression at rest. (Level of Evidence: C)

3. Adenosine or dipyridamole myocardial perfusion imaging in patients with severe coronary calcification on EBCT but with one of the following baseline ECG abnormalities:


 * a. Electronically paced ventricular rhythm (Level of Evidence: C)


 * b. Left bundle-branch block. (Level of Evidence: C)

4. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography in patients with possible myocardial ischemia on ambulatory ECG monitoring or with coronary calcification on EBCT who are unable to exercise. (Level of Evidence: C)

5. Exercise myocardial perfusion imaging or exercise echocardiography after exercise ECG testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. (Level of Evidence: C)

6. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography after exercise ECG testing in asymptomatic patients with an inadequate exercise ECG. (Level of Evidence: C)

Class III
1. Exercise ECG testing without an imaging modality in asymptomatic patients with possible myocardial ischemia on ambulatory ECG monitoring or with coronary calcification on EBCT but with the baseline ECG abnormalities listed under Class IIb1 above. (Level of Evidence: B)

2. Exercise ECG testing without an imaging modality in asymptomatic patients with an established diagnosis of CAD owing to prior MI or coronary angiography; however, testing can assess functional capacity and prognosis. (Level of Evidence: B)

3. Exercise echocardiography or dobutamine echocardiography in asymptomatic patients with left bundle-branch block. (Level of Evidence: C)

4. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography in asymptomatic patients who are able to exercise and who do not have left bundle-branch block or electronically paced ventricular rhythm. (Level of Evidence: C)

5. Exercise myocardial perfusion imaging, exercise echocardiography, adenosine or dipyridamole myocardial perfusion imaging, or dobutamine echocardiography after exercise ECG testing in asymptomatic patients with a low-risk Duke treadmill score. (Level of Evidence: C)}}

Guidelines Resources

 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina