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Table 2.1 Asymptomatic Patients Without Known ASCVD

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

34.

Low ASCVD risk < 5%*

R (2)

R (1)

R (1)

R (1)

M (4)

R (1)

R (1)

A (8)

35.

Borderline ASCVD risk 5% to 7.5%

M (4)

R (2)

R (2)

R (2)

A (7)

R (2)

R (1)

A (7)

36.

Borderline ASCVD risk 5% to 7.5% with risk-enhancing factors†

M (4)

R (3)

R (3)

R (3)

A (7)

R (3)

R (1)

A (7)

37.

Intermediate ASCVD risk 7.5% to 20% with or without risk-enhancing factors†

M (5)

R (3)

R (3)

R (3)

A (8)

R (3)

R (1)

M (5)

38.

High ASCVD risk > 20%

M (5)

M (4)

M (4)

M (4)

M (6)

M (4)

R (2)

M (5)

  1. A = Appropriate; ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium score; cath = cardiac catheterization; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; ECG = electrocardiogram; echo = echocardiography; M = May Be Appropriate; MPI = myocardial perfusion imaging; R = Rarely Appropriate
  2. *Risk calculated using the ASCVD risk estimator
  3. †See Table C, Risk-Enhancing Factors