For proper assessment of the risk-to-benefit ratio of exercise testing in patients thought to have CAD, these patients should be categorized in terms of the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines (see Technical considerations).
Class I patients include the following:
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Adult patients (including those with complete right bundle branch block or less than 1 mm of resting ST depression [at the ST80 point]) with an intermediate pretest probability of CAD on the basis of on sex, age, and symptoms; specific exceptions are noted in the descriptions of classes II and III
Class IIa patients include the following:
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Patients with vasospastic angina
Class IIb patients include the following:
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Patients with a high pretest probability of CAD on the basis of age, symptoms, and sex
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Patients with a low pretest probability of CAD on the basis of age, symptoms, and sex
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Patients with less than 1 mm of baseline ST depression who are taking digoxin
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Patients with ECG criteria for left ventricular hypertrophy (LVH) and less than 1 mm of baseline ST depression
Class III patients include the following:
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Patients with the following baseline ECG abnormalities: preexcitation syndrome (Wolff-Parkinson-White [WPW] syndrome), electronically paced ventricular rhythm, greater than 1 mm of resting ST depression, or complete left bundle branch block
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Patients with a documented MI or prior coronary angiography findings demonstrating significant disease who have an established diagnosis of CAD – Testing can help determine ischemia and risk
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Normal radionuclide uptake (dipyridamole-Cardiolite).
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Normal wall motion with radionuclide uptake.
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Inferior-wall myocardial infarct and fixed defect.
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Motion abnormalities in inferior wall consistent with inferior-wall myocardial infarction.
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Inferobasal fixed defect and lateral wall ischemia.
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Wall motion abnormalities in inferobasal region.
