Noninvasive Ischemic Imaging Stewardship in Chronic Coronary Disease: Avoiding Testing without Clinical Indication

This quality measure targets the overuse of noninvasive ischemic imaging in patients with stable chronic coronary disease (CCD), with the aim of promoting appropriate utilization, optimizing resource stewardship, and protecting patients from avoidable harm. Our findings demonstrate that despite strong clinical evidence and expert consensus, patients with stable coronary artery disease frequently undergo routine stress imaging with an absence of clinical indication often as part of habitual surveillance, or "just to check on things".

These stress imaging tests often trigger a cascade of follow-up procedures that offer no meaningful benefit. For instance, studies demonstrate that routine surveillance imaging following percutaneous coronary intervention (PCI) commonly results in additional invasive procedures, without meaningful improvements in morbidity or mortality. These tests increase healthcare costs and expose patients to potential harm from radiation or contrast exposure, false-positive findings, anxiety, and complications related to unnecessary diagnostic or therapeutic interventions, including cardiac catheterization.

Clinical practice guidelines and appropriate use criteria from leading cardiovascular societies uniformly discourage routine ischemic imaging in asymptomatic patients with known CAD. Nonetheless, a persistent gap remains between guideline-based recommendations and real-world practice. Bridging this gap offers a meaningful opportunity to reduce unnecessary expenditures and redirect clinical focus toward interventions that have been shown to improve outcomes.