44
Figure 12. Clinical Decision Pathway for Patients With Stable
Chest Pain and No Known CAD
Treatment
Stable Chest Pain + No Known CAD
Clinical risk assessment
(1)
CCTA*
(1)
Stress testing:*
Stress CMR
Stress PET
Stress SPECT
Stress echocardiography
(1)
No testing recommended
(1)
Intermediate/high risk
Inconclusive
No CAD
(no stenosis or
plaque)
Nonobstructive
CAD
(<50% stenosis)
Consider INOCA pathway as
an outpatient for frequent or
persistent symptoms
Obstructive CAD
(≥50% stenosis)
Stress testing
(2a)
FFR-CT for 40%–90% stenosis
OR
stress testing
(2a)
FFR-CT ≤0.8 or
moderate–severe
ischemia
Low risk
Exercise ECG
(2a)
Follow-up testing and intensification of GDMT by initial test results and
persistence/worsening/frequency of symptoms
CAC or exercise ECG
testing in selected cases
(2a)
YES NO
