Table 11

Appropriate Indications (Median Score 7 to 9)

IndicationAppropriateness Score (1–9)
Detection of CAD: Symptomatic—Evaluation of Chest Pain Syndrome or Anginal Equivalent
2.
  • Low pre-test probability of CAD

  • ECG uninterpretable OR unable to exercise

A (7)
3.
  • Intermediate pre-test probability of CAD

  • ECG interpretable AND able to exercise

A (7)
4.
  • Intermediate pre-test probability of CAD

  • ECG uninterpretable OR unable to exercise

A (9)
5.
  • High pre-test probability of CAD

  • Regardless of ECG interpretability and ability to exercise

A (7)
6.
  • Prior stress ECG test is uninterpretable or equivocal

A (8)
Detection of CAD: Symptomatic—Acute Chest Pain
7.
  • Intermediate pre-test probability of CAD

  • ECG—no dynamic ST changes AND serial cardiac enzymes negative

A (8)
Detection of CAD: Symptomatic—New-Onset/Diagnosed Heart Failure With Chest Pain Syndrome or Anginal Equivalent
9.
  • Intermediate pre-test probability

  • Normal LV systolic function

A (8)
Detection of CAD/Risk Assessment: Without Chest Pain Syndrome or Anginal Equivalent in Patient Populations With Defined Comorbidities—New-Onset or Diagnosed Heart Failure or LV Systolic Dysfunction
14.
  • Moderate CHD risk (Framingham)

  • No prior CAD evaluation

  • Normal LV systolic function

A (7)
Detection of CAD/Risk Assessment: Without Chest Pain Syndrome or Anginal Equivalent in Patient Populations With Defined Comorbidities—New-Onset Atrial Fibrillation
18.
  • Moderate to high CHD risk (Framingham)

  • Part of the evaluation

A (7)
Detection of CAD/Risk Assessment: Without Chest Pain Syndrome or Anginal Equivalent in Patient Populations With Defined Comorbidities—Nonsustained Ventricular Tachycardia
19.
  • Moderate to high CHD risk (Framingham)

  • Stress echo using exercise stress only

A (7)
Risk Assessment with Prior Test Results—Worsening Symptoms: Abnormal Catheterization OR Abnormal Prior Stress Imaging Study
24.
  • Re-evaluation of medically managed patients

A (8)
Risk Assessment With Prior Test Results—Asymptomatic, Prior Coronary Calcium Agatston Score
25.
  • Agatston score greater than or equal to 400

A (7)
Risk Assessment With Prior Test Results—Chest Pain Syndrome or Anginal Equivalent
27.
  • Coronary artery stenosis of unclear significance (cardiac catheterization or CT angiography)

A (8)
Risk Assessment: Preoperative Evaluation for Noncardiac Surgery—Intermediate-Risk Surgery
30.
  • Poor exercise tolerance (less than or equal to 4 METs)

  • Intermediate clinical risk predictors

A (7)
Risk Assessment: Preoperative Evaluation for Noncardiac Surgery—High-Risk Nonemergent Surgery
31.
  • Poor exercise tolerance (less than 4 METs)

A (8)
Risk Assessment: Following Acute Coronary Syndrome–UA/NSTEMI—No Recurrent Symptoms or Signs of Heart Failure
33.
  • Not planning to undergo early catheterization

A (8)
Risk Assessment: Post-Revascularization (PCI or CABG)—Symptomatic
35.
  • Evaluation of chest pain syndrome

  • Not in the early post-procedure period

A (8)
Ischemic Cardiomyopathy Assessment of Viability/Ischemia—Ischemic Cardiomyopathy, Assessment of Viability/Ischemia
42.
  • Known CAD on catheterization

  • Patient eligible for revascularization

A (8)
Stress Study for Hemodynamics (Includes Doppler During Stress)—Valvular Stenosis
43.
  • Evaluation of equivocal aortic stenosis

  • Evidence of low cardiac output

  • Use of dobutamine

A (8)
45.
  • Symptomatic individuals

  • Mild mitral stenosis

A (7)
47.
  • Asymptomatic severe AI or MR

  • LV size and function not meeting surgical criteria

A (7)
Contrast Use—Use of Contrast With Stress Echo
51.
  • Selective use of contrast

  • 2 or more contiguous segments are NOT seen on noncontrast images

A (8)