20
Diagnosis
Coronary Angiography as an Initial Testing Strategy to
Assess Risk
Î Patients with SIHD who have survived sudden cardiac death or
potentially life-threatening ventricular arrhythmia should undergo
coronary angiography to assess cardiac risk. (I-B)
Î Patients with SIHD who develop symptoms and signs of heart failure
should be evaluated to determine whether coronary angiography
should be performed for risk assessment. (I-B)
Coronary Angiography to Assess Risk After Initial Workup
With Noninvasive Testing
Î Coronary arteriography is recommended for patients with SIHD whose
clinical characteristics and results of noninvasive testing indicate a
high likelihood of severe IHD and when the benefits are deemed to
exceed risk. (I-C)
Î Coronary angiography is reasonable to further assess risk in patients
with SIHD who have depressed LV function (ejection fraction [EF]
<50%) and moderate risk criteria on noninvasive testing with
demonstrable ischemia. (IIa-C)
Î Coronary angiography is reasonable to further assess risk in patients
with SIHD and inconclusive prognostic information after noninvasive
testing or in patients for whom noninvasive testing is contraindicated
or inadequate. (IIa-C)
Î Coronary angiography for risk assessment is reasonable for patients
with SIHD who have unsatisfactory quality of life due to angina, have
preserved LV function (EF >50%), and have intermediate risk criteria
on noninvasive testing. (IIa-C)
Î Coronary angiography for risk assessment is NOT recommended in
patients with SIHD who elect not to undergo revascularization or who
are not candidates for revascularization because of comorbidities or
individual preferences. (III-B: No Benefit)
Î Coronary angiography is NOT recommended to further assess risk
in patients with SIHD who have preserved LV function (EF >50%) and
low-risk criteria on noninvasive testing. (III-B: No Benefit)
Î Coronary angiography is NOT recommended to assess risk in patients
who are at low risk according to clinical criteria and who have not
undergone noninvasive risk testing. (III-C: No Benefit)
Î Coronary angiography is NOT recommended to assess risk in
asymptomatic patients with no evidence of ischemia on noninvasive
testing. (III-C: No Benefit)
