What are the ACC/AHA guidelines for use of treadmill stress testing in the diagnosis of obstructive coronary artery disease (CAD)?

Updated: Nov 21, 2018
  • Author: David Akinpelu, MD, FACP; Chief Editor: Eric H Yang, MD  more...
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Answer

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:

  • 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:

  • Patients with vasospastic angina

Class IIb patients include the following:

  • Patients with a high pretest probability of CAD on the basis of age, symptoms, and sex

  • Patients with a low pretest probability of CAD on the basis of age, symptoms, and sex

  • Patients with less than 1 mm of baseline ST depression who are taking digoxin

  • Patients with ECG criteria for left ventricular hypertrophy (LVH) and less than 1 mm of baseline ST depression

Class III patients include the following:

  • 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

  • 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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