Randomized Evaluation of Patients With Stable Angina Comparing Diagnostic Examinations

Exclusion Criteria

• •Prior revascularization;
• •Not suitable to undergo CT with an iodinated contrast agent:
• •* Known allergy-like reaction to contrast media as defined by the American College of Radiology (ACR) (see www.acr.org/SecondaryMainMenuCategories/quality\_safety/contrast\_manual.aspx for reaction definition) or moderate to severe allergic reactions to more than one allergen;
• •* Renal failure, as determined by glomerular filtration rate (GFR) \< 30 mL/min/1.73 m2 based on a serum creatinine level obtained within 28 days prior to registration;
• •Renal insufficiency at the time of enrollment, as determined by GFR 30 to 60 mL/min/1.73 m2 based on a serum creatinine level obtained within 28 days prior to registration, unless permitted by the institution's policy and/or ACR guidance for risk reduction strategies (see www.acr.org/SecondaryMainMenuCategories/quality\_safety/contrast\_manual.aspx for guidance on contrast selection and pre-treatment strategies);
• •Atrial fibrillation or significant arrhythmia judged to potentially limit quality of CCTA;
• •Acute ischemia;
• •Acute myocardial infarction;
• •Severe myocardial ischemia: known markedly positive exercise treadmill stress test (ST) \[significant ST segment depressions or hypotensive response during stage I of the Bruce protocol\];
• •Unable to suspend respiration for 15 seconds or to follow instructions to do so;
• •Unstable angina and symptoms refractory to maximal oral and intravenous medical therapy (persistent CCS Class IV);
• •History of known left ventricular ejection fraction \< 45%;
• •Pulmonary edema or heart failure unresponsive to standard medical therapy;
• •Pacemaker;
• •Valvular heart disease likely to require surgery in the next 18 months;
• •Congenital heart disease or cardiomyopathy likely to affect prognosis during follow up;
• •Significant systemic hypertension (blood pressure \> 200/100 mm Hg) unresponsive to medical therapy;
• •Severe noncardiovascular comorbidity limiting survival (e.g., cancer or other life threatening illness for which the patient is expected to live less than 12 months);
• •Prior imaging evaluation for this episode of symptoms (e.g., SPECT MPI or CCTA within the previous 72 hours);
• •BMI \> 40 kg/m2;
• •Pregnancy or intent to become pregnant (if a female is of childbearing potential-defined as a premenopausal female capable of becoming pregnant-a pregnancy test should be done prior to enrollment).