Introduction
Computed tomography (CT) coronary angiography (CTCA) is the National Institute for Health and Care Excellence (NICE) recommended1 first-line investigation for patients with typical or atypical chest pain who have no previous diagnosis of coronary artery disease (CAD). The clinical utility of this imaging modality is underpinned by its excellent sensitivity (99%) and negative-predictive value (97%) for CAD.2 However, CTCA lacks specificity for clinically significant CAD.3,4 CTCA overestimates occlusive plaque disease, with less than half of severe stenoses causing ischaemia.3 This has led to concerns that a CTCA approach alone, wh
