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Either computed tomography angiography (CTA) or invasive coronary angiography (ICA) can be used to diagnose obstructive epicardial coronary artery disease (CAD) in patients with stable angina, but which test strategy is associated with better outcomes? In this pragmatic randomized European trial, investigators compared ICA and CTA as the initial anatomic diagnostic imaging strategy in 3651 patients with stable angina and intermediate pretest probability of CAD who were referred for ICA.
Approximately one third of the cohort underwent functional testing prior to the assigned intervention, and just over one quarter of each group had obstructive CAD (defined as a lesion of 50% or greater). During a median follow-up of 3.5 years, the primary end…