Choosing Wisely:

Don’t perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.

Rationale and Comments: Asymptomatic, low-risk patients account for up to 45% of inappropriate stress testing. Testing should be performed only when the following findings are present: diabetes in patients older than 40 years, peripheral arterial disease, and greater than 2% yearly coronary heart disease event rate.
Sponsoring Organizations:
  • American Society of Nuclear Cardiology
  • Sources:
  • ACC/AHA guidelines
  • Disciplines:
  • Cardiovascular
  • References: • Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, Pohost GM, Williams KA. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201-29.
    • Hendel RC, Abbott BG, Bateman TM, et al. Role of radionuclide myocardial perfusion imaging for asymptomatic individuals. J Nucl Cardiol. 2011;18:3-15.

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