Would it be reasonable to refer an otherwise healthy patient in their 40s for LHC after CCTA findings note significant proximal RCA stenosis, which was obtained following a transient episode of resting substernal chest pain but without subsequent reproducible symptoms with exercise?

I would favor a nuclear stress test to see if the lesion was associated with myocardial ischemia during exercise. If there was substantial evidence of ischemia, then I would proceed to LHC. If minimal or no myocardial ischemia, I would proceed with aggressive medical and lifestyle therapy.