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Figure 3 Potential Applications for Asymptomatic* Patients
Only in high CHD risk patients was RNI felt to be appropriate, although those with intermediate CHD risk with an uninterpretable ECG were uncertain. The presence of syncope did not alter the appropriateness of patients separate from their CHD risk, with low-risk patients being inappropriate and high-risk patients being appropriate. *Asymptomatic patients exhibiting the following clinical indications are appropriate (or uncertain) for RNI and do not require risk assessment by either step: 1) new-onset or newly diagnosed heart failure with LV systolic dysfunction without ischemic equivalent who have not had a prior CAD evaluation AND have no planned coronary angiography (Appropriate); 2) ventricular tachycardia (Appropriate); 3) elevated troponin without additional evidence of acute coronary syndrome (Appropriate); 4) new-onset atrial fibrillation (Uncertain).  Includes diabetes mellitus or the presence of other clinical atherosclerotic disease, including peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease, and other likely forms of clinical disease (e.g., renal artery disease).
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