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Î Exercise with nuclear MPI or echocardiography is reasonable in
patients with known SIHD who have new or worsening symptoms not
consistent with UA and who have: (IIa-B)
• at least moderate physical functioning and no disabling comorbidity,
• previously required imaging with exercise stress, or
• known multivessel disease or high risk for multivessel disease
Î Pharmacological stress imaging with nuclear MPI, echocardiography,
or CMR is NOT recommended in patients with known SIHD who have
new or worsening symptoms not consistent with UA and who are
capable of at least moderate physical functioning or have no disabling
comorbidity. (III-C: No Benefit)
Patients Unable To Exercise
Î Pharmacological stress imaging with nuclear MPI or echocardiography
is recommended in patients with known SIHD who have new or
worsening symptoms not consistent with UA and who are incapable of at
least moderate physical functioning or have disabling comorbidity. (I-B)
Î Pharmacological stress imaging with CMR is reasonable in patients
with known SIHD who have new or worsening symptoms not consistent
with UA and who are incapable of at least moderate physical
functioning or have disabling comorbidity. (IIa-B)
Î Standard exercise ECG testing should NOT be performed in patients
with known SIHD who have new or worsening symptoms not consistent
with UA and who: (III-C: No Benefit)
• are incapable of at least moderate physical functioning or
• have disabling comorbidity or
• have an uninterpretable ECG
Irrespective Of Ability To Exercise
Î CCTA for assessment of patency of CABG or of coronary stents
≥3 mm in diameter might be reasonable in patients with known
SIHD who have new or worsening symptoms not consistent with UA,
irrespective of ability to exercise. (IIb-B)
Î CCTA might be reasonable in patients with known SIHD who have new
or worsening symptoms not consistent with UA, irrespective of ability
to exercise, in the absence of known moderate or severe calcification
or if the CCTA is intended to assess coronary stents <3 mm in
diameter. (IIb-B)
Î CCTA should NOT be performed for assessment of native coronary
arteries with known moderate or severe calcification or with coronary
stents <3 mm in diameter in patients with known SIHD who have new
or worsening symptoms not consistent with UA, irrespective of ability
to exercise. (III-B: No Benefit)
