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Diagnostic and prognostic testing in coronary artery disease (CAD) is a rapidly expanding field and now includes a range of functional tests, imaging modalities and combinations of the two (stress imaging). For patients suspected of having occlusive CAD, current European Society of Cardiology and National Institute for Health and Clinical Excellence guidance1 ,2 recommends an approach where the probability of obstructive disease and the risk of future events are estimated to determine the next steps. Those at low-risk on the basis of history, examination and basic investigations do not need further assessment, while those at high-risk can proceed directly to treatment, including invasive angiography, if needed. However, for intermediate risk patients, there are a number of options.
Ideally, investigations for this population should be non-invasive, acceptable and applicable to a wide patient population and affordable for the health service. It should perform well enough to exclude the diagnosis while stratifying the risk of future events in those …