Table 7. COR and LOE for Non-Invasive Imaging in Patients with Suspected Stable CAD.

CCTA Coronary computed tomography angiography SPECT Single Photon Emission CT- Myocardial Perfusion Imaging CMR cardiac magnetic resonance CAD coronary artery disease PTP pretest probability CL clinical likelihood FFR-CT Functional flow reserve computed tomography OMT optimized medical therapy LMCA left main coronary artery CAC Coronary artery calcium exECG Exercise electrocardiography (Reproduced from ACC/AHA 2022 Guidelines [9])

	COR	LOE
Non-invasive anatomical (CCTA) or functional imaging test (SPECT, stress CMR, or stress echocardiography) is recommended for the diagnosis of CAD and assessment of event risk in patients with intermediate or high PTP of CAD	I	A
It is recommended to choose appropriate non-invasive imaging modality based on the PTP/CL sequence and patients’ characteristics (e.g., heart rate/bundle-branch block/artificial pacemaker, renal dysfunction, drug allergy/exercise intolerance, or risk of radiation exposure)	I	C
Complimentary functional tests (i.e., functional imaging tests and FFR-CT) should be considered for risk assessment or in patients whose findings on CCTA are inconclusive	IIa	B
Invasive coronary angiography should be considered for the diagnosis of CAD prior to titration of OMT when findings on non-invasive imaging tests are suggestive of LMCA or LMCA-equivalent disease, or symptoms deteriorate during diagnostic work-up	IIa	B
CAC scan or exECG may be considered as an optional test to help rule out CAD in asymptomatic or minimally symptomatic patients with low PTP	IIb	B
Invasive coronary angiography should be avoided prior to initiation and titration of OMT unless non-invasive imaging test suggest evidence of LMCA or LMCA-equivalent disease	III (Harm)	B