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Treatment
5.1.3. Intermediate-High Risk Patients With Stable Chest
Pain and No Known CAD
COR LOE
Recommendations
Anatomic Testing
1 A 1. For intermediate-high risk patients with stable chest pain and
no known CAD, CCTA is effective for diagnosis of CAD, for
risk stratification, and for guiding treatment decisions.
Stress Testing
1 B-R 2. For intermediate-high risk patients with stable chest pain and
no known CAD, stress imaging (stress echocardiography,
PET/SPECT MPI or CMR) is effective for diagnosis of
myocardial ischemia and for estimating risk of MACE.
2a B-R 3. For intermediate-high risk patients with stable chest pain and
no known CAD for whom rest/stress nuclear MPI is selected,
PET is reasonable in preference to SPECT, if available to
improve diagnostic accuracy and decrease the rate of non-
diagnostic test results.
2a B-R 4. For intermediate-high risk patients with stable chest pain
and no known CAD with an interpretable ECG and ability
to achieve maximal levels of exercise (≥5 METs), exercise
electrocardiography is reasonable.
2b B-NR 5. In intermediate-high risk patients with stable chest pain
selected for stress MPI using SPECT, the use of attenuation
correction or prone imaging may be reasonable to decrease the
rate of false-positive findings.
Assessment of Le Ventricular Function
1 B-NR 6. In intermediate-high risk patients with stable chest pain who
have pathological Q waves, symptoms or signs suggestive
of heart failure, complex ventricular arrhythmias, or a heart
murmur with unclear diagnosis, use of TTE is effective for
diagnosis of resting left ventricular systolic and diastolic
ventricular function and detection of myocardial, valvular,
and pericardial abnormalities.
