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If I am reading the abstract correctly, it seems a medical procedure was carried out here based on evidence solely from an apple watch. Other medical tests either came out fine or weren't carried out.

Doesn't that break a million rules? What if that trace was just the result of Apple testing out a new data postprocessing algorithm?

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Naah, they merely looked at Apple Watch graphs and skipped more noninvasive diagnostics directly to invasive diagnostic procedure - aka catheterization aka angiography. Angiography is the real test that can find the blockage but is invasive, so not done unless there is solid suspicion.

Summary of the paper: Apple Watch was right. They found the blockage and fixed it.

I don’t think Apple can get FCC approval if they just test new algorithms on end user devices.

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