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In 1999, the American Heart Association, American College of Cardiology, and American College of Physicians (ACP)–American Society of Internal Medicine published joint guidelines on the management of patients with chronic stable angina. Updates in 2002 and 2007 reflected advances in diagnostic imaging, medical therapies, and revascularization techniques. Five years later, we have new guidelines from the initial organizations plus additional colleagues in nursing and cardiovascular surgery. The new guidelines are broad, covering both diagnosis and management of patients with this condition, now called stable ischemic heart disease (SIHD). Reading, absorbing, and applying the numerous resulting recommendations, with their nuances and caveats, will surely challenge clinicians.

To help clinicians identify the most clinically consequential recommendations, the ACP Clinical Guidelines Committee synthesized 2 summary  documents, appearing in this issue, based on the corresponding multispecialty SIHD guideline. These summaries emphasize the recommendations identified as class I (strongly recommended) or class III (strongly recommended against). Concentrating on class I and III recommendations allows focus on areas with the strongest evidence but risks neglecting many common situations where patient care decisions are necessary despite the lack of high-quality evidence. For example, there is no class I or III recommendation regarding stress testing in a patient who has chest pain but whose symptoms and risk factors suggest a low risk for ischemic heart disease.