The recently published ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial is likely to change this practice.5 The ISCHEMIA trial compared medical therapy with invasive management in patients with proven ischaemia, after excluding patients with left main stem (LMS) stenosis with CTCA, and found no difference in outcome. We suggest that the ISCHEMIA trial results are likely to shift clinical practice towards CTCA as the primary diagnostic test for new chest pain.
Current guidelines
The updated ESC guidelines1 on new stable chest pain, published in 2019, recommended investigation based o
