(Level of Evidence: C) This section has been added to the 2014 SIHD focused update to fill a gap in the 2012 SIHD guideline.4 It specifically addresses the role of coronary angiography for the diagnosis of CAD in patients with suspected SIHD. Coronary angiography for risk stratification has been addressed in Section 3.3 of the 2012 SIHD full-text guideline.4 Recommendations for use of coronary angiography in the fol- lowing specific clinical circumstances have been addressed in other guidelines or statements and will not be discussed further here: Patients with heart failure and/or reduced ejection fraction13 Patients who have experienced sudden cardiac death or sustained ventricular arrhythmia14 Patients undergoing preoperative cardiovascular evalu- ation for noncardiac surgery (including solid organ Evaluation of cardiac disease among patients who are kidney or liver transplantation candidates16,17 Note that ACC/AHA guidelines for coronary angiography were published in 1999 but not updated, and they are now superseded by the above documents. There are no high-quality data on which to base recommen- dations for performing diagnostic coronary angiography because no study has randomized patients with SIHD to either catheter- ization or no catheterization. Trials in patients with SIHD com- paring revascularization and GDMT have, to date, all required angiography, most often after stress testing, as a prerequisite for subsequent revascularization.Additionally, the incremental ben- efit of detecting or excluding CAD by coronary angiography remains to be determined. The ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial is currently randomizing patients with at least moderate ischemia on stress testing to a strategy of optimal medi- cal therapy alone (with coronary angiography reserved for failure of medical therapy) or routine cardiac catheterization followed by revascularization (when appropriate) plus optimal medical ther- apy. 