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Stress testing:
Exercise ECG
Stress CMR
Stress echocardiography
Stress PET
Stress SPECT
(1)
Invasive coronary
angiography
(1)
CCTA
(1)
Negative
or mildly
abnormal
Discharge
Inconclusive
stenosis
Moderate-
severe
ischemia
Nonobstructive CAD
(<50% stenosis)
Discharge
Decision to
treat medically
GDMT
(1)
GDMT
(1)
Discharge
Discharge
FFR-CT
‡
OR
stress testing
(2a)
YES NO
FFR-CT ≤0.8 or
moderate-severe ischemia
Obstructive
CAD
(≥50% stenosis)
NO
High-risk CAD
†
or
frequent angina
Inconclusive
Test choice should be guided by local availability and expertise.
* Recent negative test: normal CCTA ≤2 years (no plaque/no stenosis) OR negative stress test
≤1 year, given adequate stress.
† High-risk CAD means le main stenosis ≥ 50%; anatomically significant 3-vessel disease
(≥70% stenosis).
‡ For FFR-CT, turnaround times may impact prompt clinical care decisions. However, the use of
FFR-CT does not require additional testing, as would be the case when adding stress testing.
