Although the presence of symptoms may not be a reliable means of detecting restenosis, there is no evidence that the detection of silent restenosis leads to improved outcome.852,853 Routine testing of all patients after PCI will also lead to many false-positive tests, particularly in the era of DES. As restenosis rates decline from 30% to 10%, the false-positive rate of stress imaging increases from 37% to 77%.854 A recent analysis of a national health insurance claims database and accompanying editorial find that stress testing after PCI is likely overused and rarely leads to repeat revascularization.855,856 In summary, there is no proven ben- Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e617 efit or indication for routine periodic stress testing in patients after PCI, and, thus, it is not indicated.8,851 In cases in which there is a clear clinical indication for stress testing in a patient after PCI, exercise ECG alone is an insensitive predictor of restenosis857,858; therefore, stress imaging is the preferred stress test.8 In cases of recurrent angina after PCI in which the pretest likelihood of restenosis is high and repeat revascular- ization based on symptoms is likely indicated, most practi- tioners will proceed directly to cardiac catheterization rather than first obtain stress imaging. 6.4.2. Activity and Return to Work The timing of return to physical activity depends on the presenting condition as well as previous functional status. 