Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Kevin B. Weiss, MD, MPH; Christel Mottur-Pilson, PhD; and the ACP/ACC Chronic Stable Angina Panel*
Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn, or invalid, 5 years after publication or once an update has been issued.
Grant Support: Financial support for ACP guideline development comes exclusively from the ACP operating budget.
Potential Financial Conflicts of Interest:Employment: P. Barry (Merck Institute of Aging and Health); Consultancies: R.J. Gibbons (CV Therapeutics, DOV Pharmaceuticals, King Pharm, Medicure, Boehringer Ingelheim, Hawaii Biotech, GlaxoSmithKline, TargeGen); Stock ownership or options (other than mutual funds): P. Barry (Merck & Co., Inc.); Grants received: P. Barry (Merck Company Foundation), R.J. Gibbons (Medtronic, King Pharm, Wyeth-Ayerst, Radiant Medical, Alsius Corp., TherOx, Innercool Therapies, Boston Scientific), S.V. Williams; Grants pending: R.J. Gibbons (Boehringer Ingelheim).
Requests for Single Reprints: Vincenza Snow, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Snow and Mottur-Pilson: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Barry: Merck Institute of Aging and Health, 1100 New York Avenue NW, Washington, DC 20005.
Dr. Fihn: Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, MS152, Seattle, WA 98108.
Dr. Gibbons: Mayo Clinic, 200 First Street SW, Rochester, MN 55906.
Dr. Owens: Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Williams: University of Pennsylvania, 1220 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Weiss: Hines Veterans Administration Hospital (151H), PO Box 5000, Hines, IL 60141.
In 1999, the American College of Physicians (ACP), then the American College of Physicians–American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which the ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the first of 2 that will provide guidance on the management of patients with chronic stable angina. This document will cover diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on history or on electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A future guideline will cover pharmacologic therapy and follow-up.
* This paper, written by Vincenza Snow, MD; Patricia Barry, MD, MPH; Stephan D. Fihn, MD, MPH; Raymond J. Gibbons, MD; Douglas K. Owens, MD; Sankey V. Williams, MD; Kevin B. Weiss, MD, MPH; and Christel Mottur-Pilson, PhD, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Kevin B. Weiss, MD (Chair); Mark Aronson, MD; Patricia Barry, MD; Thomas Cross Jr., MD, MPH; Nick Fitterman, MD; E. Rodney Hornbake, MD; Douglas K. Owens, MD; and Katherine D. Sherif, MD. Approved by the ACP Board of Regents in January 2004.
Table 1. Clinical Classification of Chest Pain
Evaluation of suspected coronary artery disease (CAD).
Table 2. Pretest Likelihood of Coronary Artery Disease in Symptomatic Patients, according to Age and Sex
Table 3. Patients with Coronary Artery Disease in University Centers
Algorithm for exercise electrocardiography (ECG) and angiography.
Table 4. Survival according to Risk Groups Based on Duke Treadmill Scores
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Vincenza Snow, Patricia Barry, Stephan D. Fihn, Raymond J. Gibbons, Douglas K. Owens, Sankey V. Williams, et al. Evaluation of Primary Care Patients with Chronic Stable Angina: Guidelines from the American College of Physicians. Ann Intern Med. 2004;141:57–64. doi: 10.7326/0003-4819-141-1-200407060-00015
Download citation file:
Published: Ann Intern Med. 2004;141(1):57-64.
Cardiology, Coronary Heart Disease, Guidelines.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use