The PROMISE study: a clear promise for functional stress testing in patients with suspected coronary artery disease

Excerpt

Over the years, considerable debate has arisen whether a pure anatomical test would suffice to demonstrate the significance of coronary artery disease (CAD) in patients suspected for CAD, and–more importantly–whether this anatomical information would have a bearing on clinical outcome [1, 2]. In particular, coronary computed tomography angiography (CTA) has been put forward as an optimal non-invasive anatomical imaging test to detect CAD in patients with stable CAD [3]. A number of studies has shown that CTA has a high sensitivity, reasonable specificity and an extremely high negative predictive value [4‐10]. Several large-scale studies have shown that a strategy of CTA use in the emergency department is associated with faster discharge, as compared with standard care, without a significant difference in event rates [11‐13]. However, the lack of evidence supporting CTA in randomised trials has also been mentioned. As a consequence, the relative impact of data from non-invasive anatomical testing versus functional testing on subsequent management and clinical outcomes is not fully known. …