Coronary computed tomography angiography versus stress testing in suspected coronary disease

The position of functional testing as the cornerstone of the non-invasive evaluation of patients with suspected coronary artery disease is currently being challenged by the emergence of non-invasive coronary angiography using computed tomography. Stress testing and cardiac computed tomography assess related but different aspects of ischemic heart disease, and therefore provide complementary diagnostic, and sometimes conflicting prognostic, information. While assessment of inducible ischemia is important for clinical decision making, computed tomography allows more confident exclusion of obstructive coronary artery disease in low-intermediate-risk patients. For which patient, and which situation, either modality is most useful will need to be determined in prospective clinical trials.