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2021 Chest Pain Guidelines

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48 Figure 13. Clinical Decision Pathway for Patients With Stable Chest Pain (or Equivalent) Symptoms With Prior MI, Prior Revascularization, or Known CAD on Invasive Coronary Angiography or CCTA, Including Those With Nonobstructive CAD Treatment Persistent symptoms Intensification of preventive strategies and option to defer testing (1) Stable chest pain + known CAD* Nonobstructive CAD (<50% stenosis) CCTA ± FFR-CT (FFR-CT for ≥40%–90% stenosis) OR stress testing (2a) FFR-CT ≤0.8 OR moderate-severe ischemia (2a) Invasive coronary angiography with FFR or IFR (1) GDMT according to SIHD guideline (1) Invasive coronary angiography (1) CCTA (for selected prior revascularization) § (2a) See INOCA pathway (2a) YES YES NO

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