How do you decide between obtaining routine, outpatient ETT versus stress TTE when screening for CAD, especially given insurance company preference on ETTs? 

Before getting into the opinion on the above question, it has to be said that the practice of utilizing any stress test to "screen" for coronary artery disease is currently frowned upon, and it is recommended that proceeding with a diagnostic workup should be based on the patient being both at risk for coronary disease, and having symptoms (angina) to warrant an objective evaluation of those symptoms. Even with a relatively high clinical suspicion that symptoms are coronary-related, in light of the ISCHEMIA trials, it can be argued that medical management should be tried first instead of proceeding straight to diagnostic testing. That being said, the usual practice of cardiology is more aggressive or proactive in confirming the presence of ...