The Importance of Age in Selecting a Testing Strategy for Stable Symptomatic Patients With Suspected Coronary Artery Disease

This age-based sub-group analysis was conducted within the investigator-initiated PRECISE trial, developed by academic leadership with funding and participation from HeartFlow Inc. The overall trial protocol and interpretation of results were reviewed and approved by the steering committee independently of the sponsor. Trial conduct followed the study protocol and was overseen by an independent data and safety monitoring board and the PRECISE steering committee. Operations were managed jointly by HeartFlow Inc. and the Duke Clinical Research Institute. Outcome assessments, including data and safety monitoring, event adjudication, and core lab functions, were performed independently of the sponsor. Academic authors drafted and revised the manuscript with input from HeartFlow Inc., which assisted in study conduct and data collection but did not influence outcome assessments or interpretation. The sponsor reviewed but did not prepare or approve the manuscript. The decision to publish was made independently by the lead authors and the steering committee. M.D. Kelsey: Advisory board for Bayer; Consultant/Speaker for Heartflow Inc. S. Vemulapalli: National Institutes of Health, Food and Drug Administration, American College of Cardiology, Cytokinetics, Edwards Lifesciences, Abbott Vascular; Consulting/Advisory: Astra Zeneca, Boehringer-Ingelheim, Cytokinetics, Edwards Lifesciences, Medtronic, Total CME, Ikon, Veralox Therapeutics. D.B. Mark: grant support from HeartFlow Inc. during the conduct of this study; grant support from Merck and Novo Nordisk outside the submitted work; grants or research support from NIH/NHLBI and American Heart Association; consulting fees from CeleCor, Novartis, and Boehringer Ingelheim outside the submitted work; honoraria from Elsevier outside the submitted work. C. Rogers: Employee and shareholder of HeartFlow. S. Mullen: Employee & shareholder of HeartFlow. W. Huey: Employee & shareholder of HeartFlow. A. Caune: Employee & shareholder of HeartFlow. J.A. Leipsic: Dr. Leipsic provides institutional CT core laboratory support to Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific but takes no personal compensation and is a consultant to HeartFlow and Circle CVI. R.A. Byrne: Professor Robert A. Byrne does not accept direct or personal payments from the medical device or pharmaceutical industry, reports research funding to the institution from Abbott Vascular, Biosensors, Boston Scientific, and Translumina without impact on personal remuneration. N. Ng: Employee & stock options in HeartFlow. J.E. Udelson: Dr. Udelson has received personal fees from scPharmaceuticals, Merck, Alleviant, Reprieve CV, and Cardurion. P.S. Douglas: Dr. Douglas reports relevant research support to her institution from HeartFlow and as a consultant for Cleerly. M.G. Nanna: Dr. Nanna reports consulting for Heartflow, Merck, and Novo Nordisk as well as research support from the American College of Cardiology Foundation supported by the George F. and Ann Harris Bellows Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the National Institute on Aging (K76AG088428). E. Vemmou, K. Chiswell, R.M. Clare, E. Yow, K. Pier declare no conflicts of interest. Table S1: Cardiac Catheterization Rates Among Those with Positive and Negative Testing Stratified By Population Definition, Age, and Testing Strategy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.