Analysis of 2,251 patients with suspected chronic coronary syndrome over 12.6 years revealed that NT-proBNP levels above 150 pg/mL identify those who benefit most from revascularization procedures. Patients below this threshold showed comparable mortality regardless of whether they received medical therapy or underwent coronary interventions. Above 150 pg/mL, baseline mortality risk increased nearly six-fold, but revascularization reduced death rates by 40%, though substantial risk remained. High-sensitivity troponin T also proved valuable for detecting coronary blockages, particularly in patients with very low pre-test probability where it improved diagnostic accuracy by over 10%. This biomarker-guided approach could revolutionize cardiac care by identifying which patients truly benefit from invasive procedures versus medical management alone. The findings challenge current practice patterns where revascularization decisions often rely heavily on anatomical severity rather than biological risk markers. However, this preprint awaits peer review, and the results require validation in diverse populations. The 150 pg/mL threshold represents a potentially paradigm-shifting tool for personalizing coronary intervention decisions, moving beyond anatomy-based approaches toward precision medicine in cardiovascular care.