8
Diagnosis
3.1. Diagnostic Evaluation
COR LOE
Recommendations
1 B-NR 1. In patients with CCD and a change in symptoms or
functional capacity that persists despite GDMT, stress
positron emission tomography/single photon emission
CT myocardial perfusion imaging (PET/SPECT MPI),
cardiovascular magnetic resonance (CMR) imaging, or stress
echocardiography is recommended to detect the presence
and extent of myocardial ischemia, estimate risk of major
adverse cardiovascular events (MACE), and guide therapeutic
decision-making.*
1 B-R 2. In patients with CCD and a change in symptoms or
functional capacity that persists despite GDMT, invasive
coronary angiography (ICA) is recommended for guiding
therapeutic decision-making with the goal of improving
anginal symptoms.*
2a B-R 3. In patients with CCD and a change in symptoms or
functional capacity that persists despite GDMT, when
selected for rest/stress nuclear MPI, PET is reasonable in
preference to SPECT, if available, to improve diagnostic
accuracy and decrease the rate of nondiagnostic test results.*
2a B-NR 4. In patients with CCD and a change in symptoms or
functional capacity that persists despite GDMT, exercise
treadmill testing can be useful to determine whether the
symptoms are consistent with angina pectoris, assess the
severity of symptoms, evaluate functional capacity, and guide
management.*
2a B-NR 5. In patients with CCD undergoing stress PET MPI or stress
CMR imaging, the addition of myocardial blood flow reserve
(MBFR) can be useful to improve diagnostic accuracy and
enhance risk stratification.*
2a B-NR 6. In patients with CCD and a change in symptoms or
functional capacity that persists despite GDMT, and who
have had previous coronary revascularization, coronary CT
angiography (CCTA) is reasonable to evaluate bypass graft or
stent patency (for stents ≥3 mm).*
* Modified from the recommendations in the 2021 AHA/ACC/Multisociety guideline
for the evaluation and diagnosis of chest pain. Gulati M, et al. J Am Coll Cardiol.
2021;78:e187-e285.
3. Evaluation, Diagnosis, and Risk Stratification
