50
Treatment
5.2.1.1. Patients With Prior Coronary Artery Bypass Surgery
With Stable Chest Pain
COR LOE
Recommendations
1 C-LD 1. In patients who have had prior coronary artery bypass surgery
presenting with stable chest pain whose noninvasive stress
test results show moderate to severe ischemia, or in those
suspected to have myocardial ischemia with indeterminate/
nondiagnostic stress test, ICA is recommended for guiding
therapeutic decision-making.
2a C-LD 2. In patients who have had prior coronary artery bypass surgery
presenting with stable chest pain who are suspected to
have myocardial ischemia, it is reasonable to perform stress
imaging or CCTA to evaluate for myocardial ischemia or
graft stenosis or occlusion.
5.2.2. Patients With Known Nonobstructive CAD Presenting
With Stable Chest Pain
COR LOE
Recommendations
Index Diagnostic Testing: Selecting the Appropriate Test
Anatomic Testing
2a B-NR 1. For symptomatic patients with known nonobstructive
CAD who have stable chest pain, CCTA is reasonable for
determining atherosclerotic plaque burden and progression to
obstructive CAD, and guiding therapeutic decision-making.
2a B-NR 2. For patients with known coronary stenosis from 40% to 90%
on CCTA, FFR can be useful for diagnosis of vessel-specific
ischemia and to guide decision-making regarding the use of
ICA.
Stress Testing
2a C-LD 3. For patients with known extensive nonobstructive CAD with
stable chest pain symptoms, stress imaging (PET/SPECT,
CMR, or echocardiography) is reasonable for the diagnosis of
myocardial ischemia.
