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?

For a healthy patient in their 40s with significant proximal RCA stenosis found on CCTA following a transient episode of resting substernal chest pain, and no subsequent reproducible symptoms with exercise, what would be your next step?

• Refer the patient for Left Heart Catheterization immediately
• Perform a nuclear stress test to assess for myocardial ischemia during exercise; proceed with LHC only if substantial evidence of ischemia is found
• Perform a Cardiac MRI to assess for myocardial ischemia or viability
• Perform an exercise stress echocardiogram to assess for the functional significance of the stenosis
• Other