General Approach and Overlap With Other Guidelines or Statements e362 1.6. Magnitude of the Problem e363 1.7. Organization of the Guideline e364 1.8. Vital Importance of Involvement by an Informed Patient: Recommendation e364 2. Diagnosis of SIHD e367 2.1. Clinical Evaluation of Patients With Chest Pain e367 2.1.1. Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain: Recommendations e367 2.1.2. History e367 2.1.3. Physical Examination e368 2.1.4. Electrocardiography e368 2.1.4.1. Resting Electrocardiography to Assess Risk: Recommendation e369 2.1.5. Differential Diagnosis e370 2.1.6. Developing the Probability Estimate e370 2.2. Noninvasive Testing for Diagnosis of IHD e371 2.2.1. Approach to the Selection of Diagnostic Tests to Diagnose SIHD e371 2.2.1.1. Assessing Diagnostic Test Characteristics e372 2.2.1.2. Safety and Other Considerations Potentially Affecting Test Selection e373 2.2.1.3. Exercise Versus Pharmacological Testing e374 2.2.1.4. Concomitant Diagnosis of SIHD and Assessment of Risk e374 2.2.1.5. Cost-Effectiveness e375 2.2.2. Stress Testing and Advanced Imaging for Initial Diagnosis in Patients With Suspected SIHD Who Require Noninvasive Testing: Recommendations e375 2.2.2.1. Able to Exercise e375 2.2.2.2. Unable to Exercise e376 2.2.2.3. Other e377 2.2.3. Diagnostic Accuracy of Nonimaging and Imaging Stress Testing for the Initial Diagnosis of Suspected SIHD e377 2.2.3.1. Exercise ECG e377 2.2.3.2. Exercise and Pharmacological Stress Echocardiography e377 2.2.3.3. Exercise and Pharmacological Stress Nuclear Myocardial Perfusion SPECT and Myocardial Perfusion PET e378 2.2.3.4. Pharmacological Stress CMR Wall Motion/Perfusion e378 2.2.3.5. Hybrid Imaging e378 2.2.4. Diagnostic Accuracy of Anatomic Testing for the Initial Diagnosis of SIHD e379 2.2.4.1. Coronary CT Angiography e379 2.2.4.2. CAC Scoring e379 2.2.4.3. CMR Angiography e379 3. Risk Assessment e380 3.1. Clinical Assessment e380 3.1.1. Prognosis of IHD for Death or Nonfatal MI: General Considerations e380 3.1.2. Risk Assessment Using Clinical Parameters e380 3.2. Advanced Testing: Resting and Stress Noninvasive Testing e381 3.2.1. 