Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Spectrum of IHD Guidelines relevant to the spectrum of IHD are in parentheses. CABG indicates coronary artery bypass graft; CV, cardiovascular; ECG, electrocardiogram; IHD, ischemic heart disease; PCI, percutaneous coronary intervention; SCD, sudden cardiac death; SIHD, stable ischemic heart disease; STEMI, ST-elevation myocardial infarction; UA, unstable angina; UA/NSTEMI, unstable angina/non– ST-elevation myocardial infarction; and VA, ventricular arrhythmia. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Diagnosis of Patients with Suspected Ischemic Heart Disease* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). †See Table 2 for short-term risk of death or nonfatal MI in patients with UA/NSTEMI. ‡CCTA is reasonable only for patients with intermediate probability of IHD. CCTA indicates computed coronary tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; IHD, ischemic heart disease; MI, myocardial infarction; MPI, myocardial perfusion imaging; Pharm, pharmacological; UA, unstable angina; and UA/NSTEMI, unstable angina/non–ST-elevation myocardial infarction. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Algorithm for Risk Assessment of Patients With SIHD* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). CCTA indicates coronary computed tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; LBBB, left bundle-branch block; MPI, myocardial perfusion imaging; and Pharm, pharmacological. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Algorithm for Guideline-Directed Medical Therapy for Patients With SIHD* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). †The use of bile acid sequestrant is relatively contraindicated when triglycerides are ≥200 mg/dL and is contraindicated when triglycerides are ≥500 mg/dL. ‡Dietary supplement niacin must not be used as a substitute for prescription niacin. ACCF indicates American College of Cardiology Foundation; ACEI, angiotensin- converting enzyme inhibitor; AHA, American Heart Association; ARB, angiotensin-receptor blocker; ASA, aspirin, ATP III, Adult Treatment Panel 3; BP, blood pressure; CCB, calcium channel blocker; CKD, chronic kidney disease; HDL-C, high-density lipoprotein cholesterol, JNC VII, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; LDL-C, low-density lipoprotein cholesterol; LV, left ventricular; MI, myocardial infarction; NHLBI, National Heart, Lung, and Blood Institute; and NTG, nitroglycerin. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Algorithm for Revascularization to Improve Survival of Patients With SIHD* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Algorithm for Revascularization to Improve Symptoms of Patients With SIHD* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). CABG indicates coronary artery bypass graft; PCI, percutaneous coronary intervention. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc The Ischemic Cascade Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Nomogram to Predict Risk of Death Based on Clinical Data and Results of Exercise Testing To determine risk, draw a vertical line from each risk marker to the top line, labeled “POINTS,” to calculate points for each risk marker. The sum of all these points is then marked on the line labeled “TOTAL POINTS.” Drop vertical lines from there to yield the 3- and 5-year survival probabilities. For binary variables, 1 means yes and 0 means no. MET indicates metabolic equivalent. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Euro Heart Score Sheet to Calculate Risk Score for Patients Presenting With Stable Angina (Derived From 3,779 Patients With Newly Diagnosed SIHD) *≥1 of previous cerebrovascular event; hepatic disease defined as chronic hepatitis or cirrhosis, or other hepatic disease causing elevation of transaminases ≥3 times upper limit of normal; PVD defined as claudication either at rest or on exertion, amputation for arterial vascular insufficiency, vascular surgery (reconstruction or bypass) or angioplasty to the extremities, documented aortic aneurysm, or noninvasive evidence of impaired arterial flow; chronic renal failure defined as chronic dialysis or renal transplantation or serum creatinine >200 mmol/L; chronic respiratory disease defined as a diagnosis previously made by physician or patient receiving bronchodilators or FEV1 50% predicted in previous studies; chronic inflammatory conditions defined as a diagnosis of rheumatoid arthritis, systemic lupus erythematosus or other connective tissue disease, polymyalgia rheumatica, and so on; malignancy defined as a diagnosis of malignancy within a year of active malignancy. FEV1 indicates forced expiratory volume; po2, partial pressure of oxygen; Pco2, partial pressure of carbon dioxide; and PVD, peripheral vascular disease. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Risk of Death or MI Over 1-Year After Diagnosis of SIHD According to Euro Heart Score Plot to assign estimated probability of death or nonfatal MI within 1 year of presentation according to combination of clinical and investigative features in patients with stable angina. MI indicates myocardial infarction. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Nomogram Showing the Probability of Severe (3-Vessel or Left Main) Coronary Disease Based on a 5-Point Score One point is awarded for each of the following variables: male sex, typical angina, history and electrocardiographic evidence of MI, and diabetes mellitus and use of insulin. Each curve shows the probability of severe coronary disease as a function of age. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Nomogram for Prediction of 5-Year Survival From Clinical, Physical Examination, and Cardiac Catheterization Findings Asymp indicates asymptomatic; CAD, coronary artery disease; MI, myocardial infarction; and Symp, symptomatic. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Cumulative Incidence of MACE in Patients With 3-Vessel CAD Based on SYNTAX Score at 3-Year Follow-Up in the SYNTAX Trial Treated With Either CABG (Blue) or PCI (Gold) CABG indicates coronary artery bypass graft; CAD, coronary artery disease; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention; and SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc One-Year Mortality Rates in Randomized Trials of Patients With Diabetes and Multivessel CAD, Comparing PCI (Experimental) With CABG (Control) An OR >1 suggests an advantage of CABG over PCI. ARTS1 indicates Arterial Revascularization Therapy Study I (1033); BARI I, Bypass Angioplasty Revascularization Investigation I (1005); CARDia, Coronary Artery Revascularization in Diabetes (1176); CI, confidence interval; DM, diabetes mellitus; MASS II, Medicine, Angioplasty, or Surgery Study II (1008); OR, odds ratio; SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery; and W, weighted (1006). Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Incidence of Cardiac Death or Nonfatal MI During Follow-Up After a Normal Stress MPI MI indicates myocardial infarction; MPI, myocardial perfusion imaging. Figure Legend:

Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;60(24):e44-e164. doi: /j.jacc Nomogram for Estimating 2-Year CAD Event-Free Survival (i.e., Freedom From CAD Death or Nonfatal MI) by Using Percent Ischemic Myocardium in Intermediate-Likelihood Patients by Post-Stress LV CAD indicates coronary artery disease, LVEF, left ventricular ejection fraction; MI, myocardial infarction; and SPECT, single-photon emission computed tomography. Figure Legend: