Are the current American College of Cardiology/American Heart Association stable ischemic heart disease guidelines too conservative?

The American College of Cardiology/American Heart Association stable ischemic heart disease (SIHD) practice guidelines, published in 2012, represent a tremendous collaborative effort to synthesize the existing literature and evidence base for patients with SIHD. Notably, the guidelines focus not only upon the appropriate identification of patients with SIHD, but also upon the comprehensive treatment of SIHD patients. In doing so, these guidelines have no doubt already helped numerous practicing physicians who have referenced them; however, the goal of guideline documents is not for the included recommendations to be static, but instead to dynamically adapt over time. In this editorial, we discuss three potential areas of improvement in the guidelines, ranging from the use of specific diagnostic testing and risk-stratification modalities to the preferred treatment approach for symptomatic patients with SIHD.