Version May 2024
| Grade of risk | Criteria |
| CAVEATS | Phosphodiesterase-5 inhibitors contraindicated with any nitrate preparation should not be taken with alpha-blocking agents |
| Nitrates should not be administered within 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil | |
| Low risk | No symptoms and less than three major cardiovascular risk factors (excluding gender) |
| Controlled hypertension | |
| Mild, stable angina | |
| Post-successful coronary revascularization | |
| Uncomplicated MI more than six to eight weeks previously in patients who do not have exercise-induced ischemia or who have undergone coronary revascularization | |
| Mild valvular disease | |
| Asymptomatic LV dysfunction | |
| Management | |
| Patients at low risk can safely initiate or resume sexual activity and can be treated for sexual dysfunction | |
| Intermediate or indeterminate risk | No symptoms and three or more major cardiovascular risk factors (excluding gender) |
| Moderate, stable angina | |
| Recent MI (more than two but less than six weeks previously); in patients who have not undergone revascularization, the risk can be assessed with stress testing | |
| Asymptomatic LV dysfunction with LV ejection fraction <40 percent or NYHA class II heart failure | |
| Noncardiac sequelae of atherosclerotic disease, such as peripheral vascular disease or prior stroke or transient ischemic attack | |
| Management | |
| Patients at intermediate or indeterminate risk should undergo further cardiologic evaluation, such as stress testing (particularly in patients with a sedentary lifestyle), in an attempt to restratify the patient into the high risk or low risk category | |
| High risk | Unstable or refractory angina |
| Uncontrolled hypertension | |
| NYHA class III/IV heart failure | |
| MI within the past two weeks | |
| High-risk arrhythmias | |
| Obstructive hypertrophic cardiomyopathy | |
| Moderate to severe valvular disease, particular aortic stenosis | |
| Management | |
| Patients at high risk should be stabilized by appropriate therapy before resuming sexual activity |
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