Current Evidence and Recommendations for Coronary CTA First in Evaluation of Stable Coronary Artery Disease

In the United States, functional imaging is the most commonly used method to diagnose potentially obstructive coronary artery disease (CAD) in patients with stable chest pain. However, evidence from several contemporary randomized clinical trials may advocate a new paradigm of imaging for detecting coronary atherosclerosis, not only stenosis, in low- to moderate-risk patients. Evidence from the U.K.SCOT-HEART (Scottish Computed Tomography of the Heart) trial (1) and the U.S. PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial (2) suggests that the current aim of diagnosis of stable chest pain in patients with possible obstructive CAD must change from detection of a myocardial perfusion abnormality to detection of coronary atherosclerosis, by using a coronary computed tomography (CT) angiography (CTA)–first strategy. This important scientific advance should become the critical focus of testing.

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