Table 11

Appropriate Indications (Median Rating of 7 to 9)

IndicationAppropriateness Criteria (Median Score)
Detection of CAD: Symptomatic— Evaluation of Chest Pain Syndrome
3.
  • Intermediate pre-test probability of CAD

  • ECG interpretable AND able to exercise

A (7.0)
4.
  • Intermediate pre-test probability of CAD

  • ECG uninterpretable OR unable to exercise

A (9.0)
5.
  • High pre-test probability of CAD

  • ECG interpretable AND able to exercise

A (8.0)
6.
  • High pre-test probability of CAD

  • ECG uninterpretable OR unable to exercise

A (9.0)
Detection of CAD: Symptomatic— Acute Chest Pain (in Reference to Rest Perfusion Imaging)
7.
  • Intermediate pre-test probability of CAD

  • ECG: no ST elevation AND initial cardiac enzymes negative

A (9.0)
Detection of CAD: Symptomatic— New-Onset/Diagnosed Heart Failure With Chest Pain Syndrome
9.
  • Intermediate pre-test probability of CAD

A (8.0)
Detection of CAD: Asymptomatic— New-Onset or Diagnosed Heart Failure or LV Systolic Dysfunction Without Chest Pain Syndrome
12.
  • Moderate CHD risk (Framingham)

  • No prior CAD evaluation AND no planned cardiac catheterization

A (7.5)
Detection of CAD: Asymptomatic (Without Chest Pain Syndrome)— New-Onset Atrial Fibrillation
15.
  • High CHD Risk (Framingham)

  • Part of the evaluation

A (8.0)
Detection of CAD: Asymptomatic (Without Chest Pain Syndrome)— Ventricular Tachycardia
16.
  • Moderate to high CHD risk (Framingham)

A (9.0)
Risk Assessment: General and Specific Patient Populations— Asymptomatic
19.
  • Moderate to high CHD risk (Framingham)

  • High-risk occupation (e.g., airline pilot)

A (8.0)
20.
  • High CHD risk (Framingham)

A (7.5)
Risk Assessment With Prior Test Results: Asymptomatic OR Stable Symptoms— Normal Prior SPECT MPI Study
22.
  • Normal initial RNI study

  • High CHD risk (Framingham)

  • Repeat SPECT MPI study after 2 years or greater

A (7.0)
Risk Assessment With Prior Test Results: Asymptomatic OR Stable Symptoms— Abnormal Catheterization or Prior SPECT MPI Study
24.
  • Known CAD on catheterization OR prior SPECT MPI study in patients who have not had revascularization procedure

  • Greater than or equal to 2 years to evaluate worsening disease

A (7.5)
Risk Assessment With Prior Test Results: Worsening Symptoms— Abnormal Catheterization OR Prior SPECT MPI Study
25.
  • Known CAD on catheterization OR prior SPECT MPI study

A (9.0)
Risk Assessment With Prior Test Results: Asymptomatic—Prior Coronary Calcium Agatston Score
27.
  • Agatston score greater than or equal to 400

A (7.5)
Risk Assessment With Prior Test Results: UA/NSTEMI, STEMI, or Chest Pain Syndrome—Coronary Angiogram
29.
  • Stenosis of unclear significance

A (9.0)
Risk Assessment With Prior Test Results—Duke Treadmill Score
30.
  • Intermediate Duke treadmill score

  • Intermediate CHD risk (Framingham)

A (9.0)
Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery—Intermediate-Risk Surgery
33.
  • Intermediate perioperative risk predictor OR

  • Poor exercise tolerance (less than 4 METS)

A (8.0)
Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery—High-Risk Surgery
35.
  • Minor perioperative risk predictor AND

  • Poor exercise tolerance (less than 4 METS)

A (8.0)
Risk Assessment: Following Acute Coronary Syndrome—STEMI-Hemodynamically Stable
37.
  • Thrombolytic therapy administered

  • Not planning to undergo catheterization

A (8.0)
Risk Assessment: Following Acute Coronary Syndrome—UA/NSTEMI—No Recurrent Ischemia OR No Signs of HF
39.
  • Not planning to undergo early catheterization

A (8.5)
Risk Assessment: Post-Revascularization (PCI or CABG)— Symptomatic
41.
  • Evaluation of chest pain syndrome

A (8.0)
Risk Assessment: Post-Revascularization (PCI or CABG)— Asymptomatic
44.
  • Asymptomatic prior to previous revascularization

  • Greater than or equal to 5 years after CABG

A (7.5)
45.
  • Symptomatic prior to previous revascularization

  • Greater than or equal to 5 years after CABG

A (7.5)
Assessment of Viability/Ischemia: Ischemic Cardiomyopathy (Includes SPECT Imaging for Wall Motion and Ventricular Function)
50.
  • Known CAD on catheterization

  • Patient eligible for revascularization

A (8.5)
Evaluation of Left Ventricular Function
51.
  • Non-diagnostic echocardiogram

A (9.0)
Evaluation of Ventricular Function: Use of Potentially Cardiotoxic Therapy (e.g., Doxorubicin)
52.
  • Baseline and serial measurements

A (9.0)

Note: I (Inappropriate), U (Uncertain), and A (Appropriate).