However, the performance of these same tools in predicting short-term and long-term risk for coronary mortality and coronary events might vary in patients with known SIHD as compared with patients without known disease who present with chest pain syndromes that might or might not represent angina. Although mortality and morbidity rates intuitively might be considered to be higher in patients with documented as opposed to suspected CAD, evidence-based medical management, including adherence to appropriate lifestyle changes, and possibly appropriate revas- cularization in patients with ACS or patients identified as high risk with worsening clinical status or persistent symp- toms despite GDMT, might explain the generally low mor- tality risk that has been found in several studies of patients with established SIHD.57,58,366,1216,1217 The incidence of ad- verse events during longitudinal follow-up of SIHD has declined and can be expected to vary with evolving medical management and with accruing information about the out- comes of revascularization.295,898,1163,1217 1219 Although data on serial testing are limited, one approach to identifying candidates for follow-up testing is to apply prognostic scores for detection of patients with SIHD who are at high risk of MACE. The findings of studies that have examined the prognostic value of testing among patients with known stable CAD who are receiving contemporary GDMT306,1220 1223 could provide clues for identifying candi- dates and appropriate intervals for follow-up testing. In the TIBET (Total Ischemic Burden European Trial) study group, which comprised 682 patients with stable angina and positive exercise ECG tests, adverse outcome was predicted by time to ischemia during exercise, prior infarction or prior CABG, ECG evidence for LV hypertrophy, and LV enlargement by echocardiography.58 Easily available clinical characteristics have been the strongest predictors of risk during follow-up of patients with SIHD in other studies. 