Medical Director Review

56-year-old female with known CAD, presenting with new onset exertional chest pain over the past 3 weeks. Nuclear stress test (March 18) showed anterior wall ischemia with a fixed defect involving 12% of LV myocardium. EF is 48%. Patient has been on maximum tolerated medical therapy including aspirin, atorvastatin 80mg, and metoprolol succinate 100mg daily. Prior conservative management (6 months) has failed to control symptoms. Cardiac catheterization is requested to assess coronary anatomy and guide revascularization decision-making.