Which patient would most likely be a candidate for an ischemia-guided approach in managing their coronary artery disease?

The correct answer is based on the characteristics of the patient who displays stable coronary artery disease and a favorable prognosis for an ischemia-guided approach. In this case, the 65-year-old woman with resolved ECG changes and negative troponins exemplifies a candidate for this method.

An ischemia-guided strategy is generally leveraged for patients who are stable and show no evidence of ongoing myocardial ischemia or damage. The presence of resolved ECG changes along with negative troponins indicates that she is not currently experiencing an acute coronary syndrome. This suggests that her coronary arteries, while potentially narrowed, are not causing significant ischemia at this time, making an ischemia-guided approach appropriate for her management.

In contrast, the other patients exhibit more acute or severe coronary conditions that warrant further intervention rather than an ischemia-guided strategy. For instance, the first option involves significant risk factors and abnormal T-wave changes, which suggest ongoing ischemia. The second option describes a more acute situation with ST-segment depression and positive troponins, indicative of a likely myocardial infarction. Lastly, the fourth option, involving a recent stent placement with ST-segment elevation, points toward an immediate need for coronary intervention or acute management due to potential ischemia or instability