A normal exercise nuclear MPI study or a normal exercise stress echocardiogram during which the age- predicted target heart rate is achieved is associated with a very low annual risk of cardiac death and AMI (generally ,1%) in both men and women. 2. Normal and mildly abnormal nuclear MPI or exercise stress echocardiography is associated with a low fre- quency of referral for coronary revascularization or worsening clinical status and UA admission (1.3% and Fihn et al Stable Ischemic Heart Disease: Full Text e385 3. Rates of cardiac ischemic events increase in proportion to the degree of abnormalities on stress nuclear MPI or echocardiography, with moderate to severe abnormali- ties associated with an annual risk of cardiovascular death or MI $5%.115,278,279,284,305,306,310,313,314,323 330 4. For patients with mild abnormalities, coronary angiog- raphy might be considered if the patient exhibits other features that might indicate the likelihood of high-risk CAD, including low EF on gated nuclear MPI or echocardiographic imaging331 or transient ischemic dil- atation of the left ventricle.332 5. Moderate to severe abnormalities, such as abnormal wall motion in $4 segments or multivessel abnormali- ties, indicate an increased risk (range: 6- to 10-fold) over that of patients with a normal stress imaging Nonetheless, the current literature with regard to exercise nuclear MPI or exercise echocardiography should be clarified in several ways. 