Beyond Visual Assessment of Chronic Chest Pain

A 57-year-old man with a past medical history of hypertension and dyslipidemia presented to the cardiology clinic with a 1-year history of exertional retrosternal oppressive chest pain. The pain was stable over this period of time. The cardiac examination was unremarkable. An electrocardiogram showed normal sinus rhythm without ST or T segment changes. The transthoracic echocardiography showed normal left ventricular function without segmental wall abnormality or valvulopathy. Coronary computed tomography angiography showed high calcium score with calcified lesions in the left anterior descending (LAD) artery. He subsequently underwent angiography that revealed a 60% stenosis in the mid LAD with a fractional flow reserve of 0.96 (Image 1) and a non-stenotic right coronary artery (RCA) lesion with luminal narrowing <50% (Image 2). Based on the obtained result, the patient was diagnosed with chronic stable angina, and the decision was made to treat the patient medically.

Image 1

Figure 1

Image 2

Figure 2

Which of the following statements describes the benefit that could be derived from assessing the nonculprit RCA lesion with near-infrared (NIR) spectroscopy?

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