As shown on the Figure 11 graph, some patients have a high likelihood (.50%) of having severe disease for which revascularization might improve survival on the basis of clinical parameters alone. For example, a 50-year-old male patient who has diabetes melli- tus, is taking insulin, and has typical angina and a history of previous MI has a likelihood of severe coronary stenosis .60% and thus might proceed directly to angiography if warranted by his preferences and other clinical factors, although in most circumstances stress testing will assist in planning further tests and treatments.87,252 Creation of valid, quantitative models on the basis of data from current regis- tries and trials to accurately identify patients with anatomic distributions of CAD for which revascularization has been shown to improve survival, such as left main disease, should be a research priority. Studies have suggested that addition of levels of novel biomarkers such as C-reactive protein and brain natriuretic peptide can improve prediction of mortality and cardiovas- cular events.5,57 Considerable controversy remains; however, as to whether these tests truly provide incremental informa- tion beyond more well-accepted risk factors, and few of the studies have focused on patients with SIHD.253 255 Inflamma- tory biomarkers, such as myeloperoxidase,256 biochemical markers of lipid-related atherogenic processes [lipoprotein(a), apolipoprotein B, small dense LDL, and lipoprotein- associated phospholipase A2],257,258 and low levels of circu- lating troponin detected by high-sensitivity assays259 also are under investigation as indices of risk in patients with SIHD. 3.2. Advanced Testing: Resting and Stress Noninvasive Testing 3.2.1. Resting Imaging to Assess Cardiac Structure and Function: Recommendations Class I 1. 