CCTA might be reasonable in patients with known SIHD who have new or worsening symptoms not consistent with UA, irrespective of ability to exercise, in the absence of known moderate or severe calcifi- Table 20. Follow-Up Noninvasive Testing in Patients With Known SIHD: New, Recurrent, or Worsening Symptoms Not Consistent With UA Test Exercise Status ECG Interpretable COR LOE References Additional Considerations Able Unable Yes No Patients able to exercise* Exercise ECG X X I B (114, 145 147) Exercise with nuclear MPI or Echo X X I B (172, 276, 278, 284, 306, Exercise with nuclear MPI or Echo X Any IIa B (1241, 1242) Prior requirement for imaging with exercise Known or at high risk for multivessel disease Pharmacological stress nuclear MPI/Echo/CMR X X III: No Benefit C (333) Patients unable to exercise Pharmacological stress nuclear MPI or Echo X Any I B (148 150, 152 156) Pharmacological stress CMR X Any IIa B (280, 281, 283) Exercise ECG X X III: No Benefit C N/A Irrespective of ability to exercise CCTA Any Any IIb B (1244 1248) Patency of CABG or coronary stent $3 mm diameter CCTA Any Any IIb B (158, 161, 1244) In the absence of known moderate or severe calcification and intent to assess coronary stent ,3 mm in diameter CCTA Any Any III: No Benefit B (1244 1248) Known moderate or severe native coronary calcification or assessment of coronary stent ,3 mm in diameter in patients who have new or worsening symptoms not consistent with UA *Patients are candidates for exercise testing if they are capable of performing at least moderate physical functioning (ie, moderate household, yard, or recreational work and most activities of daily living) and have no disabling comorbidity. Patients should be able to achieve 85% of age-predicted maximum heart rate. 