To maintain relevance at the point of care for practicing phy- sicians, the Task Force continues to oversee an ongoing process improvement initiative.As a result, in response to pilot projects, several changes to these guidelines will be apparent, including limited narrative text and a focus on summary and evidence tables (with references linked to abstracts in PubMed). In April 2011, the Institute of Medicine released 2 reports: Finding What Works in Health Care: Standards for Systematic Reviews and Clinical Practice Guidelines We Can Trust.2,3 It is noteworthy that the ACC/AHA practice guidelines were cited as being compliant with many of the standards that were pro- posed.A thorough review of these reports and our current meth- odology is under way, with further enhancements anticipated. The recommendations in this focused update are considered current until they are superseded in another focused update or the full-text guideline is revised. Guidelines are official policy of the ACC and AHA. Jeffrey L. Anderson, MD, FACC, FAHA Chair, ACC/AHA Task Force on Practice Guidelines These guidelines are intended to apply to adult patients with sta- ble known or suspected ischemic heart disease (IHD), including those with new-onset chest pain (ie, low-risk unstable angina) or stable pain syndromes. Patients who have ischemic equiva- lents, such as dyspnea or arm pain with exertion, are included in the latter group. Many patients with IHD may become asymptomatic with appropriate therapy. Accordingly, the follow-up sections of this guideline pertain to patients who were previously symptomatic, including those who have undergone percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). In this document, coronary angiogra- phy is understood to refer to invasive coronary angiography. 1.1. 