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Table 1.1 Symptomatic Patients With No Known CCD and No Prior Testing

From: ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease

Clinical Scenario Text

ECG Treadmill

Stress Nuclear MPI

Stress Echo

Stress CMR

CAC

CCTA

Cath

No Test

1.

Less-likely anginal symptoms with a noncardiac explanation

R (3)

R (2)

R (2)

R (2)

R (3)

R (1)

R (1)

A (8)

2.

Less-likely anginal symptoms, age < 50 y and 0 or 1 CV risk factor

M (4)

R (3)

R (3)

R (3)

M (4)

R (3)

R (1)

A (7)

3.

Less-likely anginal symptoms, age 50 y or above and/or ≥ 2 CV risk factors

M (6)

M (6)

M (6)

M (5)

M (6)

M (5)

R (2)

M (4)

4.

Likely anginal symptoms, age < 50 y and 0 or 1 CV risk factor

A (7)

A (7)

A (7)

A (7)

M (6)

A (7)

R (3)

R (3)

5.

Likely anginal symptoms, age 50 y or above and/or ≥ 2 CV risk factors

A (7)

A (8)

A (8)

A (7)

M (5)

A (7)

A (7)

R (1)

  1. CV risk factors: diabetes mellitus, smoking, family history of premature CAD, hypertension, dyslipidemia
  2. A = Appropriate; CAC = coronary artery calcium; CAD = coronary artery disease; cath = cardiac catheterization; CCD = chronic coronary disease; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CV = cardiovascular; ECG = electrocardiogram; echo = echocardiography; M = May Be Appropriate; MPI = myocardial perfusion imaging; R = Rarely Appropriate