Functional or Anatomic Testing for Patients with Chest Pain?

In 2015, several trials addressed the choice of functional or anatomic testing for patients with chest pain.

In PROMISE, investigators randomized 10,000 stable patients with suspected coronary artery disease (CAD) to either coronary computed tomographic angiography (CTA) or functional stress testing (67% nuclear stress imaging, 23% stress echocardiography, and 10% stress electrocardiography). At a mean follow-up of 25 months, incidence of a combined endpoint (death, myocardial infarction [MI], unstable angina, or major procedural complications) was similar in both groups (≈3%). Invasive angiography (12.2% vs. 8.1%) and revascularization (6.2% vs. 3.2%) were more common in the CTA group, but CTA was associated with significantly fewer cathete…