American Society of Nuclear Cardiology

View all recommendations from this society

Released April 4, 2012

Don’t perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.

Asymptomatic, low-risk patients account for up to 45 percent of inappropriate stress testing. Testing should be performed only when the following findings are present: diabetes in patients older than 40 years old, peripheral arterial disease, and greater than 2 percent yearly coronary heart disease event rate.

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 Society of Nuclear Cardiology (ASNC) appointed a writing group of content experts to identify five areas in which to make recommendations. Areas were selected for the evidence-based data available to direct provider decision-making and the potential for improving patient selection and care by eliminating inappropriate testing. Specific recommendations were drafted for each subject area, accompanied by peer-reviewed literature citations. These recommendations were reviewed by the ASNC Quality Assurance Committee and Board of Directors prior to submission to the Choosing Wisely campaign. ASNC’s disclosure and conflict of interest policy can be found at


Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, Pohost GM, Williams KA. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol 2009;53:2201–29.

Hendel RC, Abbott BG, Bateman TM, et al. Role of radionuclide myocardial perfusion imaging for asymptomatic individuals. J Nucl Cardiol. 2011;18:3-15.