As a result of small coronary artery size, tortuosity, and motion, the diagnostic accuracy of CMR angiography is reduced as compared with CCTA.224 A multicenter, controlled clinical trial of patients referred to invasive angiography revealed that magnetic resonance an- giography had an 81% negative predictive value for exclud- ing CAD.225 Several meta-analyses that included a total of 59 studies have reported diagnostic sensitivity and specificity ranging from 87% to 88% and 56% to 70%, respec- tively,158,226 with reports of a lower accuracy than that of CCTA.164 Variability in diagnostic accuracy with CMR Fihn et al Stable Ischemic Heart Disease: Full Text e379 angiography has been attributed to a lack of uniformity in pulse sequences and the application of varying analytic CMR have shown comparable abilities to detect CAD as compared with CCTA.228 No recommendations for the use of CMR angiography are included in this guideline. 3. Risk Assessment 3.1. Clinical Assessment 3.1.1. Prognosis of IHD for Death or Nonfatal MI: General Considerations IHD is a chronic disorder with a natural history that spans multiple decades. The disease typically cycles through clini- cally defined phases: asymptomatic, stable angina, accelerat- ing angina, and ACS (UA or AMI), although the progression from one state to another is not necessarily linear. The specific approach to assessing risk of subsequent adverse outcomes varies according to the patient s clinical phase, even though for those with SIHD, there is no universally accepted approach. This represents a key area for future research. The approach recommended in the present guideline is informed by the treatment goals of prolonging survival and optimizing health status and by the concept that the benefits of treatment are often proportional to the patient s underlying risk. From this perspective, it is essential to quantify the patient s prognosis as accurately as possible. 