Noninvasive Testing in Known SIHD Asymptomatic (or Stable Symptoms): Recommendations See Table 21 for a summary of recommendations from this section. Table 21. Noninvasive Testing in Known SIHD: Asymptomatic (or Stable Symptoms) Test Exercise Status ECG Interpretable Pretest Probability of Ischemia COR LOE References Additional Considerations Able* Unable Yes No Exercise or pharmacological stress with nuclear MPI, Echo, or CMR at $2-y intervals X X Prior evidence of silent ischemia or high risk for recurrent cardiac event. Meets criteria listed in additional considerations. IIa C (10, 12, 15) a) Unable to exercise to adequate workload or b) Uninterpretable ECG or c) History of incomplete coronary revascularization Exercise ECG at $1-y intervals X X Any IIb C N/A a) Prior evidence of silent ischemia OR b) At high risk for recurrent cardiac event Exercise ECG X X No prior evidence of silent ischemia and not at high risk of recurrent cardiac event. IIb C N/A For annual surveillance Exercise or pharmacological stress with nuclear MPI, Echo, or CMR or CCTA Any Any Any III: No Benefit C (10, 12, 15) a) ,5-y intervals after CABG, or b) ,2-y intervals after PCI *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. CABG indicates coronary artery bypass graft surgery; CCTA, cardiac computed tomography angiography; CMR, coronary magnetic resonance; COR, class of recommendation; CCTA, computed tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; LOE, level of evidence; MPI, myocardial perfusion imaging; N/A, not available; PCI, percutaneous coronary intervention; and SIHD, stable ischemic heart disease. 