Table 1.2.
Symptomatic Patients Without Known CCD and With Prior Testing*
| Clinical Scenario Text | ECG Treadmill | Stress Nuclear MPI | Stress Echo | Stress CMR | CAC | CCTA | Cath | No Test | |
|---|---|---|---|---|---|---|---|---|---|
| 6. | Abnormal ECG | M (4) | A (8) | A (8) | A (8) | M (5) | A (8) | M (5) | M (4) |
| 7. | Normal ET | M (6) | M (6) | M (6) | M (5) | M (6) | R (3) | M (5) | |
| 8. | Inconclusive ET | A (8) | A (8) | A (7) | M (5) | A (8) | M (5) | R (3) | |
| 9. | Abnormal ET | A (8) | A (8) | A (7) | M (4) | A (8) | A (8) | M (5) | |
| 10. | Normal stress imaging† | R (1) | R (2) | R (2) | R (2) | M (4) | A (7) | M (5) | M (6) |
| 11. | Mild ischemia on stress imaging† | R (1) | R (3) | R (3) | R (3) | R (3) | A (7) | M (6) | M (5) |
| 12. | Inconclusive stress imaging† | R (1) | M (5) | M (5) | M (5) | M (4) | A (8) | M (6) | R (3) |
| 13. | Moderate to severe ischemia on stress imaging† | R (1) | R (1) | R (1) | R (1) | R (2) | A (7) | A (9) | M (4) |
| 14. | CCTA with no CAD or up to 49% stenosis (CAD-RADS 0–2) | M (4) | M (5) | M (5) | M (5) | R (1) | R (2) | M (6) | |
| 15. | CCTA with moderate stenosis 50%-69% (CAD-RADS 3) | M (6) | A (7) | A (7) | A (7) | R (1) | A (7) | M (5) | |
| 16. | CCTA with severe stenosis ≥ 70% (CAD-RADS 4–5) | M (5) | M (6) | M (6) | M (6) | R (1) | A (8) | M (5) | |
| 17. | CCTA inconclusive (CAD-RADS N) | A (7) | A (8) | A (8) | A (8) | R (1) | A (7) | R (3) | |
| 18. | CAC score = 0 (CAC-DRS 0) | M (5) | M (6) | M (6) | M (6) | M (5) | R (1) | M (5) | |
| 19. | CAC score 1–99 (CAC-DRS 1) | M (6) | M (5) | M (6) | M (5) | M (5) | R (3) | M (5) | |
| 20. | CAC score 100–299 (CAC-DRS 2) | A (7) | A (7) | A (7) | A (7) | A (7) | M (5) | M (4) | |
| 21. | CAC score ≥ 300 (CAC-DRS 3) | A (7) | A (7) | A (7) | A (7) | M (6) | M (6) | R (3) | |
| 22. | Invasive coronary angiography with mild or no CAD and/or normal invasive physiological testing‡ | R (2) | M (3) | R (2) | M (4) | R (1) | R (1) | A (7) | |
| 23. | Invasive coronary angiography with intermediate severity and/or invasive physiological testing not done‡ | M (5) | A (7) | A (8) | A (7) | R (1) | R (1) | M (4) | |
| 24. | Invasive coronary angiography with obstructive CAD and/or abnormal invasive physiological testing‡ | R (2) | M (4) | M (4) | M (4) | R (1) | R (1) | M (4) | |
If grayed out, rating not applicable
A = Appropriate; ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium score; CAC-DRS = Coronary Artery Calcium Data and Reporting System; CAD = coronary artery disease; CAD-RADS = Coronary Artery Disease-Reporting and Data System; cath = cardiac catheterization; CCD = chronic coronary disease; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; CTCA = computed tomography coronary angiography; ECG = electrocardiogram; echo = echocardiography; ET = exercise stress test; M = May Be Appropriate; MPI = myocardial perfusion imaging; PET = positron emission tomography; R = Rarely Appropriate; SPECT = single-photon emission tomography
∗Refers to sequential testing being done as part of a continued patient evaluation or application of recent testing results in the reevaluation of a patient
†Stress imaging could be SPECT, PET, echo, or CMR
‡Refers to diagnostic angiography, not percutaneous coronary intervention