American College of Cardiology

View all recommendations from this society

Updated January 11, 2021

Avoid repeating stress testing, coronary CT angiography, or invasive coronary angiography within 2 years in asymptomatic patients or those with stable symptoms.

Performing coronary imaging or stress testing in patients without symptoms on a serial or scheduled pattern (e.g., every one to two years or at a heart procedure anniversary) rarely results in any meaningful change in patient management. This practice may lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients’ outcomes. Exceptions to this rule include patients more than five years after a bypass operation, more than 2 years after a stenting procedure, or after having a stent placed in the left main coronary artery

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Cardiology (ACC) asked its standing clinical councils to recommend between three and five procedures that should not be performed
or should be performed more rarely and only in specific circumstances. ACC staff took the councils’ recommendations and compared them to the ACC’s existing appropriate use criteria (AUC) and guidelines, choosing items for the five things list that were either Rarely Appropriate AUC recommendations or Class III guideline recommendations. The ACC’s Science and Quality Committee then reviewed and approved the final five items. ACC’s disclosure and conflict of interest policy can be found at


Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, Min JK, Patel MR, Rosenbaum L, Shaw LJ, Stainback RF, Allen JM. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease. Journ Am Coll Cardiol. 2014 Feb;63(4);380-406.