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2021 Chest Pain Guidelines

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52 Figure 14. Clinical Decision Pathway for INOCA Treatment Stable Chest Pain Suspected INOCA Invasive coronary function testing* (requires nonobstructive CAD FFR ≥0.8) (2a) CFR ≥2.0 + IMR <25 + negative provocative study to ACh CMD Vasospasm † Noncardiac Epicardial artery spasm (>90%) with ACh + reproduction of chest pain + ischemic ECG changes IMR ≥25 OR CFR <2.0 OR angina with ST depression during ACh bolus or infusion, and epicardial artery constriction Intensification of preventive strategies + symptom guided GDMT (1) Noninvasive testing more prevalent Invasive assessment more comprehensive

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