The Living Guidelines: Recommendations for Monitoring of symptoms and anti anginal therapy during follow up Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines
1. Chest X-ray for patients with evidence of new or worsening congestive heart failure (CHF). (Class I Level of Evidence: C)

2. Assessment of LV ejection fraction and segmental wall motion by echocardiography or radionuclide imaging in patients with new or worsening CHF or evidence of intervening MI by history or ECG. (Class I Level of Evidence: C)

3. Echocardiography for evidence of new or worsening valvular heart disease. (Class I Level of Evidence: C)

4. Treadmill exercise test for patients without prior revascularization who have a significant change in clinical status, are able to exercise, and do not have any of the ECG abnormalities listed below in number 5. (Class I Level of Evidence: C)


 * a. Pre-excitation (Wolff-Parkinson-White) syndrome. (Class I Level of Evidence: C)


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


 * c. >1 mm of ST depression in resting ECG. (Class I Level of Evidence: C)


 * d. Complete left bundle branch block (LBBB). (Class I Level of Evidence: C)

5. Stress radionuclide imaging or stress echocardiography procedures for patients without prior revascularization who have a significant change in clinical status and are unable to exercise or have one of the following ECG abnormalities:


 * a. Pre-excitation (Wolff-Parkinson-White) syndrome. (Class I Level of Evidence: C)


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


 * c. >1 mm of ST depression in resting ECG. (Class I Level of Evidence: C)


 * d. Complete left bundle branch block (LBBB). (Class I Level of Evidence: C)

6. Stress radionuclide imaging or stress echocardiography procedures for patients who have a significant change in clinical status and required a stress imaging procedure on their initial evaluation because of equivocal or intermediate-risk treadmill results. (Class I Level of Evidence: C)

7. Stress radionuclide imaging or stress echocardiography procedures for patients with prior revascularization who have a significant change in clinical status. (Class I Level of Evidence: C)

8. Coronary angiography in patients with marked limitation of ordinary activity (CCS class III) despite maximal medical therapy. (Class I Level of Evidence: C)