What are the criteria for choosing a stress test for patients with NSTE-ACS?
The criteria for choosing a stress test for patients with NSTE-ACS include the patient's resting ECG and the patient's ability to exercise, local expertise, and available technologies. The exercise intensity of the treadmill test (low level or symptom-limited) is used at the discretion of the attending clinician based on individual patient assessment. Noninvasive stress testing is recommended in low- and intermediate-risk patients who have been free of ischemia at rest or with low-level activity, while treadmill exercise testing is useful in patients able to exercise in whom the ECG is free of resting ST changes that may interfere with interpretation. Stress testing with an imaging modality should be used in patients who are able to exercise but have ST changes on resting ECG that may interfere with interpretation. For those unable to exercise adequately, pharmacological stress testing with imaging is recommended. A noninvasive imaging test is also recommended to evaluate LV function in patients with definite ACS.