Chest Pain, CAD, and Asthma

A 72-year-old woman with severe asthma, type 2 diabetes mellitus, and a history of coronary artery disease treated 10 years ago with 2-vessel coronary artery bypass grafting presented to the emergency department with chest pain. She reported Canadian Cardiovascular Society Class III angina over the past 3-4 months, increasing in frequency from a few times a week to multiple times daily. She had no symptoms at rest.

The initial electrocardiogram was normal, and her high-sensitivity troponin level was elevated to 42 ng/L (n < 14 ng/L). Due to concerns for acute coronary syndrome, the patient was referred for coronary angiography, which revealed calcified vessels with poor distal runoff and no options for revascularization. An echocardiogram showed normal left ventricular ejection fraction.

Which of the following is recommended as first-line anti-anginal therapy in this patient?

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