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(New page: __NOTOC__ {{Chronic stable angina}} {{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}; Smita Kohli, M.D. ==ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD a...)
 
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{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}; Smita Kohli, M.D.
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}; Smita Kohli, M.D.


==ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>==
==ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>==
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===Class IIb===
===Class IIb===
'''1.''' [[Chronic stable angina exercise electrocardiography|Exercise ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] ([[AECG]]) monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] in the absence of one of the following [[ECG]] abnormalities:
'''1.''' [[Chronic stable angina exercise electrocardiography|Exercise ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] ([[AECG]]) monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] in the absence of one of the following [[ECG]] abnormalities:
:a. Preexcitation ([[Wolff-Parkinson-White syndrome]]) ''(Level of Evidence: C)''
 
:b. Electronically paced ventricular rhythm ''(Level of Evidence: C)''
:'''a.''' Preexcitation ([[Wolff-Parkinson-White syndrome]]) ''(Level of Evidence: C)''
:c. More than 1 mm of [[ST depression]] at rest ''(Level of Evidence: C)''
 
:d. Complete [[left bundle-branch block]]. ''(Level of Evidence: C)''
:'''b.''' Electronically paced ventricular rhythm ''(Level of Evidence: C)''
 
:'''c.''' More than 1 mm of [[ST depression]] at rest ''(Level of Evidence: C)''
 
:'''d.''' Complete [[left bundle-branch block]]. ''(Level of Evidence: C)''


'''2.''' Exercise perfusion imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are able to exercise and have one of the following baseline [[ECG]] abnormalities:
'''2.''' Exercise perfusion imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are able to exercise and have one of the following baseline [[ECG]] abnormalities:
:a. Preexcitation ([[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White]]) syndrome ''(Level of Evidence: C)''
:b. More than 1 mm of ST depression at rest. ''(Level of Evidence: C)''


'''3.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging in patients with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] but with one of the following baseline [[ECG]] abnormalities:
:'''a.''' Preexcitation ([[Wolff-Parkinson-White syndrome]]) ''(Level of Evidence: C)''
:a. Electronically paced ventricular rhythm ''(Level of Evidence: C)''
 
:b. [[Left bundle-branch block]]. ''(Level of Evidence: C)''
:'''b.''' More than 1 mm of [[ST depression]] at rest. ''(Level of Evidence: C)''
 
'''3.''' [[Adenosine]] or [[dipyridamole]] [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|myocardial perfusion imaging]] in patients with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] but with one of the following baseline [[ECG]] abnormalities:
 
:'''a.''' Electronically paced ventricular rhythm ''(Level of Evidence: C)''
 
:'''b.''' [[Left bundle-branch block]]. ''(Level of Evidence: C)''


'''4.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are unable to exercise. ''(Level of Evidence: C)''
'''4.''' [[Adenosine]] or [[dipyridamole]] [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|myocardial perfusion imaging]] or [[dobutamine]] [[echocardiography]] in patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are unable to exercise. ''(Level of Evidence: C)''


'''5.''' Exercise [[myocardial perfusion]] imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. ''(Level of Evidence: C)''
'''5.''' Exercise [[myocardial perfusion]] imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. ''(Level of Evidence: C)''


'''6.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with an inadequate exercise [[ECG]]. ''(Level of Evidence: C)''
'''6.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with an inadequate [[Chronic stable angina exercise electrocardiography|exercise ECG]]. ''(Level of Evidence: C)''


===Class III===
===Class III===
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'''4.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in asymptomatic patients who are able to exercise and who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: C)''
'''4.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in asymptomatic patients who are able to exercise and who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: C)''


'''5.''' Exercise myocardial perfusion imaging, [[Chronic stable angina exercise echocardiography|exercise echocardiography]], [[adenosine]] or [[dipyridamole]] myocardial perfusion imaging, or [[dobutamine]] [[echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with a low-risk Duke treadmill score. ''(Level of Evidence: C)''}}
'''5.''' Exercise myocardial perfusion imaging, [[Chronic stable angina exercise echocardiography|exercise echocardiography]], [[adenosine]] or [[dipyridamole]] myocardial perfusion imaging, or [[dobutamine]] [[echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with a low-risk Duke treadmill score. ''(Level of Evidence: C)''}}


==See Also==
==See Also==

Revision as of 14:32, 19 July 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.

ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT)[1][2]

“

Class IIb

1. Exercise ECG testing without an imaging modality in asymptomatic patients with possible myocardial ischemia on ambulatory ECG (AECG) monitoring or with severe coronary calcification on EBCT in the absence of one of the following ECG abnormalities:

a. Preexcitation (Wolff-Parkinson-White syndrome) (Level of Evidence: C)
b. Electronically paced ventricular rhythm (Level of Evidence: C)
c. More than 1 mm of ST depression at rest (Level of Evidence: C)
d. Complete left bundle-branch block. (Level of Evidence: C)

2. Exercise perfusion imaging or exercise echocardiography in asymptomatic patients with possible myocardial ischemia on ambulatory ECG monitoring or with severe coronary calcification on EBCT who are able to exercise and have one of the following baseline ECG abnormalities:

a. Preexcitation (Wolff-Parkinson-White syndrome) (Level of Evidence: C)
b. More than 1 mm of ST depression at rest. (Level of Evidence: C)

3. Adenosine or dipyridamole myocardial perfusion imaging in patients with severe coronary calcification on EBCT but with one of the following baseline ECG abnormalities:

a. Electronically paced ventricular rhythm (Level of Evidence: C)
b. Left bundle-branch block. (Level of Evidence: C)

4. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography in patients with possible myocardial ischemia on ambulatory ECG monitoring or with coronary calcification on EBCT who are unable to exercise. (Level of Evidence: C)

5. Exercise myocardial perfusion imaging or exercise echocardiography after exercise ECG testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. (Level of Evidence: C)

6. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography after exercise ECG testing in asymptomatic patients with an inadequate exercise ECG. (Level of Evidence: C)

Class III

1. Exercise ECG testing without an imaging modality in asymptomatic patients with possible myocardial ischemia on ambulatory ECG monitoring or with coronary calcification on EBCT but with the baseline ECG abnormalities listed under Class IIb1 above. (Level of Evidence: B)

2. Exercise ECG testing without an imaging modality in asymptomatic patients with an established diagnosis of CAD owing to prior MI or coronary angiography; however, testing can assess functional capacity and prognosis. (Level of Evidence: B)

3. Exercise echocardiography or dobutamine echocardiography in asymptomatic patients with left bundle-branch block. (Level of Evidence: C)

4. Adenosine or dipyridamole myocardial perfusion imaging or dobutamine echocardiography in asymptomatic patients who are able to exercise and who do not have left bundle-branch block or electronically paced ventricular rhythm. (Level of Evidence: C)

5. Exercise myocardial perfusion imaging, exercise echocardiography, adenosine or dipyridamole myocardial perfusion imaging, or dobutamine echocardiography after exercise ECG testing in asymptomatic patients with a low-risk Duke treadmill score. (Level of Evidence: C)

”

See Also

Sources

  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [3]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [4]

References

  1. ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
  2. ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
  3. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  4. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462


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