28
Treatment
Figure 9. Evaluation Algorithm for Patients With Suspected
ACS at Intermediate Risk With No Known CAD
Acute Chest Pain
+
Intermediate-Risk With No Known CAD
Prior testing
Recent negative test*
Prior moderate-
severely abnormal ≤1 y
(no interval coronary
angiography [ICA])
Prior inconclusive
or mildly abnormal
stress test ≤1 y
CCTA
(2a)
Nonobstructive CAD
(<50% stenosis)
Inconclusive
stenosis
Obstructive CAD
(≥50% stenosis)
Discharge
Discharge
FFR-CT
‡
OR
stress testing
(2a)
Consider INOCA
pathway as
an outpatient
for frequent
or persistent
symptoms
Decision to
treat medically
GDMT
(1)
Discharge
GDMT
(1)
Discharge
Invasive coronary
angiography
(1)
YES
YES NO
High-risk
CAD
†
or
frequent
angina
FFR-CT ≤0.8 or
moderate-severe
ischemia
