The PRECISE trial: How should patients with chest pain be tested?

Article Figures & Data

TABLE 1

PRECISE trial at a glance

	Precision strategy (n = 1,057)	Usual-testing strategy (n = 1,046)
Intervention	Risk stratification using PROMISE minimal risk score: if score was > 0.46, then further testing was deferred unless patients had known vascular calcifications or atherosclerosis Cardiac testing with CT angiography: if 30% to 90% stenosis was present, then CT fractional flow reserve was added	Physician-guided decision-making: options included deferred testing, stress testing, or cardiac catheterization

Patients who had cardiac testing, n (%)	883 (83.5)^{^a}	978 (93.5)^{^a}

Initial cardiac testing, %
CT angiography	48	< 1
CT angiography + CT fractional flow reserve	31	< 1
Cardiac catheterization	< 1	10
Single-photon emission computed tomography-positron emission tomography	2	32
Stress echocardiography	2	30
Treadmill electrocardiography	1	11
Stress cardiac magnetic resonance imaging	< 1	10
No test	16	7

Patients who had cardiac catheterization, n (%)	135 (12.8)^{^a}	177 (16.9)^{^a}

Patients with primary composite endpoint (death, nonfatal myocardial infarction, or cardiac catheterization without obstructive coronary artery disease), n (%)	44 (4.2)^{^a}	118 (11.3)^{^a}
Death or nonfatal myocardial infarction	18 (1.7)	12 (1.1)
Cardiac catheterization without obstructive coronary artery disease	27 (2.6)^{^a}	107 (10.2)^{^a}

Patients who had revascularization, n (%)	97 (9.2)^{^a}	54 (5.2)^{^a}

↵^a Statistically significant difference.
CT = computed tomography; PRECISE = Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization; PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain
Based on information from reference 7.