ACC/AHA Guidelines for Coronary Angiography: Executive Summary and Recommendations
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) Developed in collaboration with the Society for Cardiac Angiography and Interventions
Figure 1.
Nomogram of prognostic relations embodied in the Duke Treadmill Score. Determination of prognosis proceeds in 5 steps: 1. The observed amount of exercise-induced ST-segment deviation (the largest elevation or depression after resting changes have been subtracted) is marked on the line for ST-segment deviation during exercise. 2. The observed degree of angina during exercise is marked on the line for angina. 3. The marks for ST-segment deviation and degree of angina are connected with a straight edge. The point where this line intersects the ischemia reading line is noted. 4. The total number of minutes of exercise in treadmill testing according to the Bruce protocol (or the equivalent in multiples of resting oxygen consumption [METs] from an alternative protocol) is marked on the exercise-duration line. 5. The mark for ischemia is connected with that for exercise duration. The point at which this line intersects the line for prognosis indicates the 5-year survival rate and average annual mortality for patients with these characteristics. Patients with <1 mm of exercise-induced ST-segment depression should be counted as having 0 mm. Angina during exercise refers to typical effort angina or an equivalent exercise-induced symptom that represents the patient’s presenting complaint. This nomogram applies to patients with known or suspected CAD, without prior revascularization or recent MI, who undergo exercise testing before coronary angiography. Modified with permission from Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325:849–853. © 1991 Massachusetts Medical Society. All rights reserved.
Figure 2.
Clinical context for noninvasive and invasive diagnostic testing of patients with known or suspected ischemic heart disease. *ECG interpretable unless preexcitation, electronically paced rhythm, left BBB, or resting ST-segment depression >1 mm. See text for discussion of use of digoxin, left ventricular hypertrophy, and ST-segment depression <1 mm. **For example, high risk if Duke treadmill score predicts average annual mortality >3%. Modified from Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol.1997;30:260–311.
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Table 1.
Noninvasive Test Results Predicting High Risk1 for Adverse Outcome