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ARKA Clinical Decision Support is designed to meet all four criteria for Non-Device CDS under FD&C Act §520(o)(1)(E) and FDA's January 2026 final guidance on Clinical Decision Support Software. Recommendations support, not replace, the clinician's judgment. Every recommendation is anchored in a published guideline or peer-reviewed source, with the basis available for independent review. CLIN emphasizes imaging appropriateness at order entry.

This recommendation is intended to support, not replace, clinical judgment. It is generated by ARKA, software designed to meet the four criteria for Non-Device Clinical Decision Support under FD&C Act §520(o)(1)(E) and FDA's final guidance on Clinical Decision Support Software (January 2026). The clinician is responsible for the final decision.

Regulatory rationale Feature catalog Trust center

Evidence library

AIIE Evidence

Stable chest pain — functional stress imaging pathway

Cardiac

Last reviewed 2026-06-01

Knowledge Matrix v1.0.0

Clinical bottom line

Choose stress imaging for stable chest pain when the clinical question is ischemic burden — anatomy and function pathways are both guideline-supported.

Summary

Stress imaging (echo, nuclear MPI, or stress CMR) is the functional alternative for stable chest pain, preferred when ischemic burden quantification will guide revascularization decisions or when CCTA is limited by calcification or rhythm.

Key points

PROMISE found comparable outcomes between anatomic and functional strategies.
ISCHEMIA showed that even moderate-severe ischemia does not mandate invasive management without symptoms refractory to therapy.
Prior revascularization and heavy coronary calcium favor functional testing.

Citations

The AIIE synthesis above is ARKA-authored; the sources below are the underlying external literature.

Gulati M, et al. 2021 AHA/ACC guideline for the evaluation and diagnosis of chest pain
Circulation · 2021doi:10.1161/CIR.0000000000001029
Douglas PS, et al. Outcomes of anatomical versus functional testing for coronary artery disease (PROMISE)
New England Journal of Medicine · 2015doi:10.1056/NEJMoa1415516
Maron DJ, et al. Initial invasive or conservative strategy for stable coronary disease (ISCHEMIA)
New England Journal of Medicine · 2020doi:10.1056/NEJMoa1915922

Stable chest pain — coronary CTA as first-line anatomic test Pre-operative evaluation with symptoms or high-risk surgery — targeted testing

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Clinical bottom line

Summary

Key points

Citations

Related evidence

Clinical bottom line

Summary

Key points

Citations

Related evidence