Functional or Anatomic Testing for Patients with Stable Chest Pain?

Functional (i.e., stress) or anatomic (i.e., coronary computed tomographic angiography [CTA]) testing is used commonly to investigate new-onset chest pain, but which strategy leads to better outcomes? Investigators randomized 10,000 stable patients (mean age, 61; average estimated pretest probability of coronary artery disease [CAD], 53%) with suspected CAD to a strategy of initial testing with either CTA or functional testing. Functional-test choice was at the discretion of the treatment team: 67% of patients underwent nuclear stress imaging, 22% underwent stress echocardiography, and 10% underwent stress electrocardiography.

After a mean 25-month follow-up, the primary endpoint (death, myocardial infarction, hospitalization for unstable an…