A 72-Year-Old Asymptomatic Man Presenting for Routine Follow-Up

A 72-year-old man with a history of hypertension, diabetes, hyperlipidemia, and coronary artery disease complicated by a prior inferior myocardial infarction (MI) and coronary artery bypass graft five years ago presents to cardiology clinic for routine follow-up. He is very active and reports an unlimited exercise tolerance. He denies chest pain, dyspnea, or lower extremity edema. He is compliant with his medications which include aspirin 81 mg daily, metoprolol succinate 25 mg daily, lisinopril 5 mg, and crestor 5 mg daily. On exam, he is a well-appearing man with a blood pressure of 147/86 and heart rate of 82 beats per minute. His examination is unremarkable. Routine ECG is ordered and is shown below. It is unchanged from his baseline ECG. A transthoracic echocardiogram obtained two months ago reveals an ejection fraction of 50-55% with akinesis of the basal inferior wall. Recent fasting lipids are notable for an LDL of 107 mg/dL, HDL of 54 mg/dL, and TG 168. He is referred for an exercise nuclear stress test and moderate anterior ischemia is identified. The patient did not have any symptoms during the stress test.

Figure 1
Figure 1: A 72-Year-Old Asymptomatic Man Presenting for Routine Follow-Up

Which of the following statements about this patient is correct?

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