How should patients be categorized prior to administration of treadmill stress testing?

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

For proper evaluation, risk assessment, and prognosis in symptomatic patients or those with CAD, these patients should be categorized in terms of the ACC/AHA guidelines (see Technical considerations).

Class I patients include the following:

  • Patients undergoing initial evaluation with possible or known CAD, including those with complete right bundle branch block or less than 1 mm of resting ST depression; specific exceptions are noted in the description of class IIb

  • Patients with possible or known CAD who were previously evaluated and are now presenting with a significant change in clinical status

  • Low-risk patients with unstable angina 8-12 hours after presentation who have been free of active ischemic or heart failure symptoms (level of evidence: B)

  • Intermediate-risk patients with unstable angina 2-3 days after presentation who have been free of active ischemic or heart failure symptoms (level of evidence: B)

Class IIa patients include the following:

  • Intermediate-risk patients with unstable angina who have normal initial cardiac markers, a repeat ECG without significant change, normal cardiac markers 6-12 hours after the onset of symptoms, and no other evidence of ischemia during observation (level of evidence: B)

Class IIb patients include the following:

  • Patients with the following resting ECG abnormalities: preexcitation syndrome (WPW syndrome), electronically paced ventricular rhythm, resting ST depression greater than 1 mm, complete left bundle branch block, or any interventricular conduction defect with a QRS duration greater than 120 msec

  • Patients with a stable clinical course who undergo periodic monitoring to guide treatment

Class III patients include the following:

  • Patients with severe comorbidity likely to limit life expectancy, candidacy for revascularization, or both

  • High-risk patients with unstable angina (level of evidence: C)


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