The PRECISE Protocol: Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization
The PRECISE Protocol: Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization
The study will be a prospective, pragmatic, randomized clinical trial of the comparative
 effectiveness of diagnostic evaluation strategies for stable CAD, to be performed in
 outpatient settings, including primary care and cardiology practices.
Inclusion criteria (all must be present):

 1. Age ≥18 years

 2. Stable typical or atypical symptoms suggesting possible significant coronary artery
 disease (CAD) with further non-emergent testing or elective catheterization
 recommended to evaluate the presence of suspected significant CAD. Stable chest pain
 (or equivalent) includes those who have fully been ruled out for Acute Coronary
 Syndrome (ACS) and for whom elective testing is recommended, regardless of the venue
 in which they are seen.

 3. If prior CV testing has occurred, it must have been performed greater than one year
 prior to randomization, and the following must be met:

 1. cCTA or invasive coronary angiography (ICA) with stenosis < 50%

 2. Quantified coronary artery calcium (CAC) < 100 AG

 4. Safe performance of cCTA:

 1. Creatinine clearance ≥45 ml/min per most recent measurement within 90 days

 2. For a female participant of childbearing potential (those who have not been
 surgically sterilized or are not postmenopausal), a pregnancy test must be
 performed with negative results known within 7 days prior to randomization

 5. Willingness to comply with all aspects of the protocol, including adherence to the
 assigned strategy and follow-up visits

 6. Ability to provide written informed consent

 Exclusion criteria (all must be absent):

 1. Acute chest pain (in patients who have not been ruled out for ACS)

 2. Unstable clinical status

 3. Noninvasive or invasive CV testing for CAD within 1 year. CV testing for CAD refers to
 any stress tests, invasive coronary angiography (ICA) and cCTA (including calcium
 scoring) only.

 a. Resting ECG, resting echocardiogram and resting CMR (MRI) are not exclusionary
 regardless of when were performed

 4. Lifetime history of known obstructive CAD (prior myocardial infarction, CABG or PCI,
 stenosis ≥50%), known EF ≤40% or other moderate to severe valvular or congenital
 cardiac disease

 5. Contraindications to cCTA including but not limited to creatinine clearance (GFR) <45
 ml/min as per most recent measurement taken within 90 days

 6. Exceeds the site's weight or size limit for cCTA or cardiac catheterization

 7. Any condition leading to possible inability to comply with the protocol procedures or
 follow-up

 8. Any condition that might interfere with the study procedures or follow-up

 9. Enrolled in an investigational trial that involves a non-approved cardiac drug or
 device which has not reached its primary endpoint

 10. Life expectancy less than 2 years due to non-cardiovascular comorbidities