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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Exercise testing* before and after revascularization Class I - There is evidence and/or general agreement that exercise testing before and after revascularization should be performed in the following settings: •  To demonstrate ischemia before revascularization. •  To evaluate recurrent symptoms suggesting ischemia after revascularization. Class IIa - The weight of evidence or opinion is in favor of benefit from exercise testing before and after revascularization in the following setting: •  After discharge, to assist in activity counseling and/or exercise training as part of cardiac rehabilitation. Class IIb - The evidence or opinion is less well established that exercise testing before and after revascularization is beneficial in the following settings: •  To detect restenosis in selected high-risk asymptomatic patients within the first 12 months after percutaneous coronary intervention (PCI). •  Periodic monitoring of selected, high-risk asymptomatic patients to detect tenosis, graft occlusion, incomplete coronary revascularization, or disease progression. High risk includes patients with decreased left ventricular function, multivessel or proximal left anterior descending disease, a suboptimal PCI results, diabetes, prior sudden death, or a hazardous occupation. Class III - There is evidence that exercise testing before and after revascularization is not useful and may be harmful in the following settings: •  To localize ischemia to determine the site of intervention. •  For routine, periodic monitoring of asymptomatic patients after PCI or coronary artery bypass grafting. * Because of the relatively low sensitivity with exercise ECG testing (due in part to the high prevalence of single vessel disease), exercise stress imaging with SPECT or echocardiography is preferred. From Gibbons, RJ, Balady, GJ, Bricker, JT, et al. ACC/AHA 2002 Guideline Update for Exercise Testing: a report of the American College of Cardiology/American Heart Association Task Force on practice Guidelines (Committee on Exercise Testing). Circulation 2002; 106:1883.