Coronary Computed Tomography Angiography as the First-Line Test: What Downstream Testing It Prevents and What It Generates

Abstract

Guidelines now endorse both coronary computed tomography angiography (CTCA) and functional (stress) testing as
reasonable first-line strategies for the initial evaluation of stable chest pain, leaving the choice between them to local
practice and patient factors. That equivalence in guideline standing has obscured a genuine empirical question: the two
strategies generate different downstream testing cascades, and it is those downstream consequences, not the index test alone,
that determine what a patient actually experiences after the scan.