Abstract
BACKGROUND: Coronary artery disease (CAD) poses a significant global health burden, necessitating optimal diagnostic strategies for risk assessment and management. This study systematically reviews randomized controlled trials (RCTs) comparing different noninvasive imaging modalities for CAD evaluation, focusing on their subsequent invasive outcomes and major adverse cardiac events (MACEs). METHODS: A comprehensive electronic search was conducted across multiple databases, identifying 24 relevant RCTs published between 2010 and 2023. Key outcomes assessed included downstream referral to invasive testing, MACE rates, cost-effectiveness, and hospitalization outcomes. RESULTS: The majority of included RCTs focused on comparing coronary computed tomography angiography (CCTA) with alternative imaging techniques. While CCTA is often associated with increased invasiveness, it demonstrates slightly better MACE rates, cost-effectiveness, and hospitalization outcomes compared to other imaging modalities. CONCLUSION: Continued investigation into alternative noninvasive diagnostic methods for CAD is essential to advance clinical practice and optimize patient care. By exploring new strategies beyond CCTA and leveraging technological innovations, health-care providers can improve diagnostic precision, mitigate procedural risks, and ultimately enhance outcomes for individuals with CAD.