What would be your threshold to offer coronary angiography for patients presenting with atypical chest pain features and Wellens syndrome on EKG without a troponin elevation or dynamic EKG changes?

For patients presenting with atypical chest pain features and Wellens syndrome on EKG without troponin elevation or dynamic EKG changes, what is your approach to deciding when to offer coronary angiography?

• Proceed directly to cardiac catheterization based on the Wellens syndrome presentation
• Consider high-quality cardiac CT angiography (CTA) as an alternative to evaluate the coronary arteries
• Rely on additional non-invasive stress testing before deciding on coronary angiography
• Monitor the patient clinically and reassess if symptoms or EKG changes evolve
• Other