What is your go-to non-invasive test for the evaluation of angina in the primary care setting?

Great question, but not a simple answer! In my experience, there is no "go-to" noninvasive test for the evaluation of angina in the primary care setting. That is because each noninvasive test has its own strengths and pitfalls, which must be judiciously applied in the selection process for the individual patient with different clinical scenarios and risk factors. Let's first review the type of noninvasive tests available for chest pain evaluation.

1. Treadmill (TM) stress test
2. TM exercise stress echocardiography (echo)
3. TM nuclear stress test (SPECT)
4. Bicycle exercise stress echo
5. Bicycle exercise stress SPECT
6. Dobutamine stress echo
7. Dobutamine SPECT
8. Vasodilator stress SPECT
9. Vasodilator stress PET
10. Vasodilator stress MRI
11. Coronary CTA

They use dif...