Assess the risk of future cardiac events.

The risk of exercise testing in appropriately selected candidates is extremely low, and thus the main argument for not performing an exercise test is that the extra information provided would not be worth the extra cost of obtaining that information or the test might provide misinformation that could lead to inappropriate testing or therapy.

• Unless cardiac catheterization is indicated, completed or planned symptomatic patients with suspected or known CAD should usually undergo exercise testing to assess the risk of future cardiac events, unless they have confounding features on the rest ECG.
• Patients undergoing only a submaximal exercise stress test (EST) prior to discharge for an acute coronary syndrome (ACS) should receive a symptom-limited EST at 3 to 6 weeks from discharge.

Cardiac stress testing is indicated in the initial evaluation of all patients with known IHD (with the exceptions noted above), unless there are criteria for proceeding directly to cardiac catheterization and coronary arteriography (see Referral to Cardiology ).

Patients with evidence for inducible ischemia during risk stratification should be considered for further cardiac evaluation, such as coronary arteriography. Repeat cardiac stress testing is indicated if there has been a significant change in symptoms or decrement in exercise tolerance; however, routine periodic stress testing is not indicated.