46
Treatment
5.2. Patients With Known CAD Presenting With Stable Chest
Pain
COR LOE
Recommendations
1 A 1. For patients with obstructive CAD and stable chest pain, it is
recommended to optimize GDMT.
1 C-EO 2. For patients with known nonobstructive CAD and stable
chest pain, it is recommended to optimize preventive
therapies.
5.2.1. Patients With Obstructive CAD Who Present With
Stable Chest Pain
COR LOE
Recommendations
Index Diagnostic Testing
Anatomic Testing
1 A 1. For patients with obstructive CAD who have stable chest
pain despite GDMT and moderate-severe ischemia, ICA is
recommended for guiding therapeutic decision-making.
1 A 2. For patients with obstructive CAD who have stable chest
pain despite optimal GDMT, those referred for ICA without
prior stress testing benefit from FFR or instantaneous wave
free ratio.
1 B-R 3. For symptomatic patients with obstructive CAD who have
stable chest pain with CCTA-defined ≥50% stenosis in the
left main coronary artery, obstructive CAD with FFR with
CT ≤0.80, or severe stenosis (≥70%) in all 3 main vessels,
ICA is effective for guiding therapeutic decision-making.
2a B-NR 4. For patients who have stable chest pain with previous
coronary revascularization, CCTA is reasonable to evaluate
bypass graft or stent patency (for stents ≥3 mm).
