When there is little expectation of an improvement in survival from revascularization, patients should be so informed. When evidence points to probable benefit from either revascular- ization or medical therapy, it should be quantified to the extent possible, with explicit acknowledgment of uncertain- ties, and should be discussed in the context of what treatment option is best for that particular patient. When possible, the relative time course of response to therapy should be de- scribed for therapeutic choices. Some patients might, for example, initially opt for PCI over medical therapy because relief of symptoms is typically more rapid. However, when informed of the immediate risk of complications of PCI, some Figure 3. Algorithm for risk assessment of patients with SIHD.* *Colors corre- spond to the class of recommendations in the ACCF/AHA Table 1. The algo- rithms do not represent a comprehen- sive list of recommendations (see text for all recommendations). CCTA indi- cates coronary computed tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; LBBB, left bundle-branch block; MPI, myocardial perfusion imaging; and Pharm, pharmacological. patients could prefer conservative therapy. Similarly, many patients choose PCI over CABG because it is less invasive and provides for quicker recovery, despite the fact that repeat revascularization procedures are performed more frequently after PCI. Patients preferences in these circumstances often are influenced by their attitudes toward risk and by the tendency to let immediate smaller benefits outweigh larger future risks, a phenomenon termed temporal discounting. 51 2. Diagnosis of SIHD 2.1. Clinical Evaluation of Patients With Chest Pain 2.1.1. Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain: Recommendations Class I 1. 