Noninvasive testing strategies in symptomatic, intermediate-risk CAD patients: a perspective on the "PROMISE" trial and its potential implementation in clinical practice.

While the results of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain trial (PROMISE trial) are negative for the primary outcome, the results from this large, contemporary trial of >10,000 patients provide important insights into clinical management of patients presenting with chest pain. The results reinforce that while diagnostic testing is an important component of modern management, its choice should be directed by a clinician in a clinical context and with subsequent management in mind. Based on presentation and pre-test probability, the clinician will decide if any additional testing necessary is necessary and if that is the case chose the most appropriate test according to current guidelines, applied to the individual patient and clinical scenario.