title: Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain).
abstract: BACKGROUND
  Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing.
  
  
  METHODS
  In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA). Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. The primary end point was death, myocardial infarction, or unstable angina hospitalizations over a median follow-up of 26.1 months.
  
  
  RESULTS
  Both the prevalence of normal test results and incidence rate of events in these patients were significantly lower among 4500 patients randomly assigned to CTA in comparison with 4602 patients randomly assigned to functional testing (33.4% versus 78.0%, and 0.9% versus 2.1%, respectively; bothP<0.001). In CTA, 54.0% of events (n=74/137) occurred in patients with nonobstructive CAD (1%-69% stenosis). Prevalence of obstructive CAD and myocardial ischemia was low (11.9% versus 12.7%, respectively), with both findings having similar prognostic value (hazard ratio, 3.74; 95% confidence interval [CI], 2.60-5.39; and 3.47; 95% CI, 2.42-4.99). When test findings were stratified as mildly, moderately, or severely abnormal, hazard ratios for events in comparison with normal tests increased proportionally for CTA (2.94, 7.67, 10.13; allP<0.001) but not for corresponding functional testing categories (0.94 [P=0.87], 2.65 [P=0.001], 3.88 [P<0.001]). The discriminatory ability of CTA in predicting events was significantly better than functional testing (c-index, 0.72; 95% CI, 0.68-0.76 versus 0.64; 95% CI, 0.59-0.69;P=0.04). If 2714 patients with at least an intermediate Framingham Risk Score (>10%) who had a normal functional test were reclassified as being mildly abnormal, the discriminatory capacity improved to 0.69 (95% CI, 0.64-0.74).
  
  
  CONCLUSIONS
  Coronary CTA, by identifying patients at risk because of nonobstructive CAD, provides better prognostic information than functional testing in contemporary patients who have stable chest pain with a low burden of obstructive CAD, myocardial ischemia, and events.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01174550.
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.). uhoffmann@mgh.harvard.edu.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Megan
authors.initials: M
authors.lastname: Huang
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Michael
authors.initials: M
authors.lastname: Pencina
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Fordyce
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: George
authors.initials: G
authors.lastname: Nahhas
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chow
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Boston (U.H., M.H.P.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Tufts University School of Medicine and the CardioVascular Center, Tufts Medical Center, Boston, MA (J.E.U.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P., M.H., M.P., D.B.M., C.B.F., A.S.K., K.L.L., P.S.D.); Cardiovascular Research, New York Methodist Hospital, Brooklyn (J.F.H.); Mayo Clinic, Rochester, MN (P.A.P.); Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); Cardiology, Beaumont Hospital-Dearborn, MI (G.N.); and Department of Medicine, Ottawa Heart Institute, Ontario, Canada (B.C.).
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017023:Coronary Angiography / Q000379:methods / Q000592:standards*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods / Q000592:standards*; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*
keywords: coronary artery disease; diagnostic tests, routine; prognosis