Abstract 18053: Prognostic Value of Anatomic versus Functional Diagnostic Testing in Symptomatic Patients With Suspected CAD: The PROMISE Trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain)

Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. functional testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to functional testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and functional testing. Results: Overall, 4516 patients received CTA and 4572 functional testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42...