Table 4. Risk Assignment for Cardiovascular Complications That Can Develop with Exercise

Low Risk Moderate Risk High Risk
Ischemia Atherosclerosis risk factors (+) Ischemia/angina at moderate to high intensity exercise levels (> 7METs) Ischemia/angina at low intensity exercise levels (< 5METs)
History of CAD but no current ischemia or evidence of atherosclerosis within 1 year Stable after an ischemic event, coronary artery bypass graft, or angiographic intervention Complex coronary anatomy not amenable to intervention or revascularization
Normal EST Controlled at lower intensity exercises with medications
Arrhythmia Nonsustained, rate-controlled supraventricular arrhythmias with no hemodynamic compromise Rapid supraventricular arrhythmias with or without symptoms but no hemodynamic compromise Any arrhythmias with hemodynamic compromise
Unifocal, infrequent (<10%) premature ventricular contractions Multifocal premature ventricular contractions, couplets, triplets, or history of nonsustained ventricular tachycardia Recent history of ventricular tachycardia, ventricular fibrillation, or asystole
Patients with pacemakers Patients with ICDs
Pump failure Remote history of CHF controlled with medications Active CHF controlled with medications CHF at rest or with mild intensity exercise
NYHA Class I NYHA Class II NYHA Class III or IV
Mild left ventricular dysfunction (EF > 50%) Moderate left ventricular dysfunction (EF 40%-50%) Moderate to severe left ventricular dysfunction (EF < 40%)
Normal or blunted rise (5-20 mmHg) in systolic blood pressure with moderate-intensity exercise Blunted or no rise (0-5 mmHg) in systolic blood pressure with mild-to moderate-intensity exercise Recent history of a fall in systolic blood pressure with or after exercise
CAD: coronary artery disease, EST: exercise stress test, NYHA: New York Heart Association classification, EF: ejection fraction, MET: metabolic equivalent, CHF: chronic heart failure, ICD: implantable cardioverter defibrillator