Unable to Exercise
Î Pharmacological stress with nuclear MPI or echocardiography is
recommended for patients with an intermediate to high pretest
probability of IHD who are incapable of at least moderate physical
functioning or have disabling comorbidity. (I-B)
Î Pharmacological stress echocardiography is reasonable for patients
with a low pretest probability of IHD who require testing and are
incapable of at least moderate physical functioning or have disabling
comorbidity. (IIa-C)
Î CCTA is reasonable for patients with a low to intermediate pretest
probability of IHD who are incapable of at least moderate physical
functioning or have disabling comorbidity. (IIa-B)
Î Pharmacological stress CMR is reasonable for patients with an
intermediate to high pretest probability of IHD who are incapable of
at least moderate physical functioning or have disabling comorbidity.
(IIa-B)
Î Standard exercise ECG testing is NOT recommended for patients who
have an uninterpretable ECG or are incapable of at least moderate
physical functioning or have disabling comorbidity. (III-C: No Benefit)
Î CCTA is reasonable for patients with an intermediate pretest
probability of IHD who: (IIa-C)
• have continued symptoms with prior normal test findings, or
• have inconclusive results from prior exercise or pharmacological stress testing, or
• are unable to undergo stress with nuclear MPI or echocardiography
Î For patients with a low to intermediate pretest probability of
obstructive IHD, noncontrast cardiac computed tomography (CT) to
determine the coronary artery calcium (CAC) score may be considered.
(IIb-C)
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