What is the best management for patients with evidence of asymptomatic ischemia on exercise stress testing?
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Patients with intermediate- or high-risk Duke Treadmill Score (DTS) on exercise stress testing (EST) should undergo myocardial perfusion imaging or exercise echocardiography, especially if they have abnormal values of Chronotropic Index or post-EST Heart Rate Recovery. For patients who have a low-risk DTS, the 4-year mortality is less than 1% to 2%; therefore, risk-factor reduction without further investigation is appropriate (strength of recommendation: B, based on cohort studies and consensus guideline).
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