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4.1.2.2. Intermediate-Risk Patients With Acute Chest Pain
and Known CAD
COR LOE
Recommendations
1 A 1. For intermediate-risk patients with acute chest pain who
have known CAD and present with new onset or worsening
symptoms, GDMT should be optimized before additional
cardiac testing is performed.
1 A 2. For intermediate-risk patients with acute chest pain who have
worsening frequency of symptoms with significant left main,
proximal left anterior descending stenosis, or multivessel
CAD on prior anatomic testing or history of prior coronary
revascularization, ICA is recommended.
2a B-NR 3. For intermediate-risk patients with acute chest pain
and known nonobstructive CAD, CCTA can be useful
to determine progression of atherosclerotic plaque and
obstructive CAD.
2a B-NR 4. For intermediate-risk patients with acute chest pain and
coronary artery stenosis of 40% to 90% in a proximal or
middle segment on CCTA, FFR-CT is reasonable for
diagnosis of vessel-specific ischemia and to guide decision-
making regarding the use of coronary revascularization.
2a B-NR 5. For intermediate-risk patients with acute chest pain and
known CAD who have new onset or worsening symptoms,
stress imaging (PET/SPECT MPI, CMR, or stress
echocardiography) is reasonable.
Treatment
