Should CCTA be considered the diagnostic test of choice in the outpatient evaluation of chest pain?

CCTA can not likely stand as a way of perfectly excluding ischemic heart disease, but neither can any test, such as ETT, SET, MRA, etc.

As such, it seems attractive to individualize screening tests and even employ a complementary array of techniques.

I think it should be individualized based on the patient’s clinical picture.

CCTA uses an anatomy-based approach to assess pathology; FFR-CT adds the ability to assess physiology. So, in theory, CCTA or CCTA-FFR should be the ideal one-stop shop. However, the evaluation of CP in the outpatient setting needs far more in comprehension, than the concise approach of CT. The exercise stress test, with imaging, offers a peek into exercise functional capacity, exercise arrhythmic burden, exercise hemodynamic response, exercise symptom response and finally, exercise ischemic burden. For those purveyors of the see-lesion-assess-lesion-fix approach, CCTA +/- FFR-CT may offer all that’s needed. But for those that want more, the exercise stress imaging model may serve the purpose.