stable ischemic heart disease

Definition

SIHD refers to asx and stably sx Pts as well as low-risk new-onset chest pain felt to be due to IHD, and excludes Pts w/ rapidly progressive sx or rest sx (ie, ACS)

Noninvasive testing (Circ 2012;126:e354 & 2021;144;e368)

• Noninvasive dx testing most valuable when pretest probability is intermediate (variably defined as anywhere from 30–70% to 10–90%)

• Several pretest probability scores that take into account age, sex, nature of sx, risk factors

• Exercise ECG testing or CAC reasonable in some low-risk Pts

• In intermediate/high-risk Pts, stress test w/ imaging or CCTA (see “Noninv Eval of CAD”)

• If known nonobstructive CAD & stable chest pain: stress testing or CCTA ± FFR

• If obstructive CAD & stable chest pain: stress testing or invasive angio if high-risk CAD

• Coronary-angiography-for-SIHD (Circ 2014;130:1749)

• Major-risk-factor-modification-stable ischemic heart disease (Circ 2012;126:e354)

• Optimal-medical-therapy-stable ischemic heart disease (OMT) (Circ 2012;126:e354)

• Revascularization (JAMA 2021;325:1765; Circ 2022;145:e18)