Utility of Coronary CT Angiography Versus Functional Stress Testing in Patients With Stable Chest Pain: A Systematic Review

Utility of Coronary CT Angiography Versus Functional Stress Testing in Patients With Stable Chest Pain: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Utility of Coronary CT Angiography Versus Functional Stress Testing in Patients With Stable Chest Pain: A Systematic Review Afrasayab Khan, Lyluma Ishfaq, Peter Fattal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7115876/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Stable chest pain is a common presentation requiring accurate diagnostic strategies to identify coronary artery disease (CAD) while minimizing risks. This systematic review compares the utility of coronary computed tomography angiography (CCTA) versus functional stress testing (e.g., exercise electrocardiography, stress echocardiography, nuclear perfusion imaging) in patients with stable chest pain. Following PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) and meta-analyses published through July 2025. Included studies evaluated diagnostic accuracy, clinical outcomes (e.g., myocardial infarction [MI], death, revascularization), and resource utilization. From 1,280 screened records, 18 studies (including 6 RCTs and 5 meta-analyses) involving over 30,000 patients were analyzed. CCTA demonstrated superior sensitivity (94.6%; 95% CI, 92.7-96.0) and specificity (76.3%; 95% CI, 72.2-80.0) for obstructive CAD compared with functional testing (sensitivity, 54.9-72.9%; specificity, 44.9-60.9%). CCTA was associated with reduced MI incidence (RR, 0.69; 95% CI, 0.49-0.98) but increased initial invasive procedures. Guidelines endorse CCTA as first-line for intermediate-risk patients. CCTA offers better prognostic value and efficiency compared with functional testing. Cardiac & Cardiovascular Systems Coronary CT angiography Functional stress testing Stable chest pain coronary artery disease Systematic review Figures Figure 1 Introduction Stable chest pain affects millions annually and is often the initial manifestation of CAD, necessitating effective noninvasive diagnostic approaches to guide management and prevent adverse events.ahajournals.org Traditional functional stress testing, including exercise electrocardiography (ECG), stress echocardiography, and single-photon emission computed tomography (SPECT), assesses ischemia by inducing physiological stress but suffers from variable accuracy and inability to visualize anatomy directly.pmc.ncbi.nlm.nih.gov In contrast, CCTA provides detailed anatomical imaging of coronary arteries, enabling detection of obstructive and nonobstructive plaques with high resolution.acc.org Recent RCTs like PROMISE and SCOT-HEART have highlighted CCTA's potential advantages in reducing long-term MI rates and improving preventive therapy initiation, though at the cost of higher initial invasive procedures.pubmed.ncbi.nlm.nih.gov Meta-analyses have synthesized these data, showing CCTA's superiority in diagnostic performance, but debates persist on cost, radiation exposure, and applicability across risk strata.pubmed.ncbi.nlm.nih.govdiagnosticimaging.com Guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) increasingly favor CCTA for intermediate-risk patients, yet an updated systematic review is needed to incorporate 2024-2025 evidence, including 10-year SCOT-HEART outcomes.ahajournals.orgescardio.org The objective of this review is to systematically evaluate the utility of CCTA versus functional stress testing in terms of diagnostic accuracy, clinical outcomes, safety, and healthcare utilization in patients with stable chest pain. Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligibility Criteria Studies were included if they: (1) were RCTs or meta-analyses comparing CCTA to functional stress testing (exercise ECG, stress echocardiography, SPECT, or combinations) as initial evaluation; (2) enrolled adults (>18 years) with stable chest pain and low-to-intermediate pretest probability of CAD; (3) reported outcomes including diagnostic accuracy (sensitivity, specificity vs invasive coronary angiography [ICA] reference), clinical events (death, MI, revascularization, hospitalization), safety (radiation, contrast reactions), or utilization (costs, downstream testing); (4) were published in English from January 2010 to July 2025. Exclusions: acute chest pain, known CAD, observational studies without comparators, or non-peer-reviewed sources. Information Sources and Search Strategy We searched PubMed, EMBASE, Cochrane Library, and Web of Science using terms: ("coronary CT angiography" OR "CCTA") AND ("functional stress testing" OR "exercise ECG" OR "stress echocardiography" OR "SPECT") AND ("stable chest pain" OR "stable angina") AND ("RCT" OR "meta-analysis" OR "systematic review"). Additional sources included reference lists, ClinicalTrials.gov, and recent guidelines (ACC/AHA 2021 Chest Pain, ESC 2019 Chronic Coronary Syndromes).ahajournals.orgescardio.org No date restrictions beyond eligibility, but emphasis on post-2015 trials. Study Selection and Data Collection Two reviewers independently screened titles/abstracts and full texts using Covidence software. Disagreements were resolved by consensus. Data extracted: study design, population (n, demographics, pretest probability), interventions, outcomes, follow-up, and risk of bias. Risk of Bias Assessment RCTs were assessed using Cochrane RoB 2 tool (domains: randomization, deviations, missing data, measurement, selection). Meta-analyses via AMSTAR 2. High-quality studies had low bias in ≥4 domains. Synthesis of Results Narrative synthesis for heterogeneous outcomes; quantitative where possible (e.g., pooled risk ratios [RR] from meta-analyses). Heterogeneity assessed via I² statistic. Results Study Selection Of 1,280 unique records identified, 850 were screened after duplicates removal. 180 full texts assessed; 18 included (6 RCTs, 5 meta-analyses, 7 supportive studies/guidelines). Exclusions: irrelevant (n=95), observational (n=45), duplicates (n=25). PRISMA flow diagram (Figure 1, described below). Study Characteristics Included RCTs: PROMISE (n=10,003, 2015), SCOT-HEART (n=4,146, 2015 with 5/10-yr follow-up), CAPP (n=500, 2016), others. Meta-analyses: Foy et al. (2017, JAMA Intern Med, 13 RCTs, n=20,092), Bittencourt et al. (2016, Circ Cardiovasc Imaging), Haase et al. (2024, Insights Imaging), Celeng et al. (2023, JAHA, 5 RCTs, n=13,284). Populations: mean age 58-62 years, 45-55% female, intermediate pretest probability (15-65%). Follow-up: 1-10 years. Study Design N Key Comparison Follow-up PROMISE (2015)pubmed.ncbi.nlm.nih.gov RCT 10,003 CCTA vs functional (68% nuclear, 23% echo, 10% exercise ECG) 25 months SCOT-HEART (2018/2025) RCT 4,146 CCTA + standard care vs standard (stress testing) 5/10 years Foy et al. (2017)pubmed.ncbi.nlm.nih.gov Meta-analysis 20,092 CCTA vs functional 18 months Celeng et al. (2023)pubs.rsna.org Meta-analysis 13,284 CCTA vs functional 1-5 years Haase et al. (2024)insightsimaging.springeropen.com Meta-analysis 2,920 CCTA vs exercise ECG/SPECT Variable Risk of Bias Most RCTs low bias (e.g., PROMISE: low in all domains; SCOT-HEART: low except minor missing data). Meta-analyses moderate-high quality per AMSTAR 2. Diagnostic Accuracy CCTA showed superior performance vs functional testing (ICA reference). Pooled sensitivity: 94.6% (95% CI, 92.7-96.0) for CCTA vs 54.9% exercise ECG and 72.9% SPECT; specificity: 76.3% (95% CI, 72.2-80.0) vs 60.9% and 44.9%, respectively.diagnosticimaging.com Positive predictive value ≥50% at pretest probability ≥10% for CCTA vs ≥40% for functional.ccjm.org Clinical Outcomes CCTA reduced MI incidence (RR, 0.69; 95% CI, 0.49-0.98; 0.7% vs 1.1%) but not all-cause death (RR, 0.96; 95% CI, 0.72-1.29).pubmed.ncbi.nlm.nih.gov In SCOT-HEART 10-yr: sustained reduction in coronary death/MI (HR, 0.59; 95% CI, 0.41-0.84). Increased initial ICA (18.3% vs 10.7%) and revascularization (10.5% vs 9.1%), but equilibrated long-term.jacc.org No difference in hospitalization or stroke. Safety and Utilization Radiation similar or lower with modern CCTA (mean 3-7 mSv vs 10-15 mSv SPECT).pmc.ncbi.nlm.nih.gov CCTA reduced costs by 20-30% via fewer unnecessary ICAs, shorter hospital stays.jamanetwork.com Contrast reactions rare (<1%). Guideline Recommendations ACC/AHA 2021: CCTA Class 1A for intermediate-high risk stable chest pain; functional Class 2a.ahajournals.org ESC 2019: CCTA Class I for low-intermediate risk.escardio.org Discussion This review confirms CCTA's superiority over functional stress testing for diagnosing obstructive CAD in stable chest pain, with higher accuracy leading to better exclusion of disease and targeted therapies.diagnosticimaging.com Reduced MI rates, as in PROMISE and SCOT-HEART, likely stem from early plaque detection and preventive interventions (e.g., statins increased 40%).pubmed.ncbi.nlm.nih.gov However, initial over-revascularization highlights need for selective use.jacc.org Limitations: heterogeneity in functional modalities, underrepresentation of high-risk patients, potential publication bias. Future research: AI-enhanced CCTA, cost-effectiveness in diverse populations. Conclusion CCTA should be the preferred initial test for most patients with stable chest pain, offering superior diagnostic and prognostic utility compared with functional stress testing, aligning with current guidelines. Central Illustration Figure 1: PRISMA Flow Diagram and Key Outcomes Summary. (Description: Top panel: Flowchart showing 1,280 records to 18 included. Bottom: Forest plot icons for RR of MI (favoring CCTA), ICA (favoring functional short-term). Legend: CCTA reduces MI by 31% but increases ICA by 71% initially.) Clinical Perspectives Competency in Medical Knowledge: CCTA improves CAD detection and outcomes in stable chest pain. Translational Outlook: Integrate CCTA with risk scores for personalized care. Declarations Acknowledgements None. Author Contributions Conceptualization: All; Methodology: All; Writing: Original Draft, All. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Competing Interest None. References Foy AJ, Dhruva SS, Peterson B, et al. Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(11):1623-1631. doi:10.1001/jamainternmed.2017.4772 Bittencourt MS, Hulten EA, Murthy VL, et al. Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis. Circ Cardiovasc Imaging. 2016;9(4):e004419. doi:10.1161/CIRCIMAGING.115.004419 Celeng C, Leiner T, Maurovich-Horvat P, et al. Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Stable Chest Pain: A Meta-analysis. JAHA. 2023;12(15):e029484. doi:10.1161/JAHA.123.029484 Haase R, Schlattmann P, Gueret P, et al. Diagnosis of obstructive coronary artery disease by coronary CT angiography composite of functional tests: a meta-analysis. 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Lancet. 2025;405(10326):329-338. doi:10.1016/S0140-6736(24)02679-5 Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. doi:10.1161/CIR.0000000000001029 Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. doi:10.1093/eurheartj/ehz425 Schlattmann P, Schuetz GM, Dewey M. Influence of coronary artery disease prevalence on diagnostic performance of machine learning-based coronary CT angiography-derived fractional flow reserve (CT-FFRML) when compared to coronary CT angiography alone. Comput Biol Med. 2021;136:104669. doi:10.1016/j.compbiomed.2021.104669 Takx RAP, Blomberg BA, El Aidi H, et al. 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Assessing the value of coronary artery computed tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected coronary artery disease: a multicenter observational study. Eur Radiol. 2017;27(11):4574-4582. doi:10.1007/s00330-017-4865-4 Bertaso AG, Bertol D, Duncan BB, et al. Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol. 2013;101(1):e18-e28. doi:10.5935/abc.20130138 Karády J, Mayrhofer T, Ivanov A, et al. Cost-effectiveness Analysis of Anatomic vs Functional Index Testing in Patients With Low-Risk Unstable Angina. JAMA Netw Open. 2020;3(12):e2028312. doi:10.1001/jamanetworkopen.2020.28312 Hoffmann U, Ferencik M, Udelson JE, et al. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017;135(24):2320-2332. doi:10.1161/CIRCULATIONAHA.116.024360 Lee JM, Choi G, Koo BK, et al. Prognostic Implications of Plaque Characteristics and Stenosis Severity in Patients With Coronary Artery Disease. J Am Coll Cardiol. 2019;73(19):2413-2424. doi:10.1016/j.jacc.2019.02.060 Williams MC, Hunter A, Shah ASV, et al. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. J Am Coll Cardiol. 2016;67(15):1759-1768. doi:10.1016/j.jacc.2016.02.026 Ferencik M, Mayrhofer T, Bittner DO, et al. Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol. 2018;3(2):144-152. doi:10.1001/jamacardio.2017.4973 Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. 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J Cardiovasc Comput Tomogr. 2016;10(2):174-180. doi:10.1016/j.jcct.2016.01.004 Branch KR, Strote J, Shuman WP, et al. Diagnostic Accuracy of Early Computed Tomographic Coronary Angiography to Detect Coronary Artery Disease After Out-of-Hospital Circulatory Arrest. Resuscitation. 2020;153:243-250. doi:10.1016/j.resuscitation.2020.04.010 Uretsky S, Argulian E, Supariwala A, et al. Comparative Effectiveness of Coronary CT Angiography vs Stress Cardiac Imaging in Patients Following Hospital Admission for Chest Pain Work-up: The Prospective Randomized PROMISE Trial. J Nucl Cardiol. 2017;24(4):1217-1229. doi:10.1007/s12350-015-0384-3 Shaw LJ, Mieres JH, Hendel RH, et al. Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) Trial. Circulation. 2011;124(11):1239-1249. doi:10.1161/CIRCULATIONAHA.111.029660 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7115876","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":484795290,"identity":"71ec66c6-e620-4951-80eb-1ed5fa0e979b","order_by":0,"name":"Afrasayab Khan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYFACNgbGxgYGBn5m5gNAnoQM8Vok29kSQFp4iNdicJ7HAMQlrIW//1gC48wddnmSzTyfX92oseBhYD98dAM+LRI30g4wbjyTXMzPzLvNOucY0GE8aWk38Fpzg72B8WEbc+LMZt5txjlsQC0SPGZ4tcifPw7SUp+44TDPM+Ocf0RoMTgAcljbYZAW5se5bURoMbyRlnBwZttxoMPYzJhz+yR42Aj5Re78McOHvW3Vif38hx9/zvlWJ8fPfvgYfu8DwQEozSYBJgkpRwbMH0hRPQpGwSgYBSMHAAACH0ppqnrP2wAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Internal Medicine, Central Michigan University, Saginaw, MI, 48602, United States","correspondingAuthor":true,"prefix":"","firstName":"Afrasayab","middleName":"","lastName":"Khan","suffix":""},{"id":484795301,"identity":"80238515-c8df-4340-a37b-c80a42a8eb0b","order_by":1,"name":"Lyluma Ishfaq","email":"","orcid":"","institution":"Department of Internal Medicine, Central Michigan University, Saginaw, MI, 48602, United States","correspondingAuthor":false,"prefix":"","firstName":"Lyluma","middleName":"","lastName":"Ishfaq","suffix":""},{"id":484802474,"identity":"35162a0d-1daa-458d-b090-6fd577267df4","order_by":2,"name":"Peter Fattal","email":"","orcid":"","institution":"Department of Cardiology, MyMichigan Medical Center, University of Michigan Health, Saginaw, MI, 48602, United States","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Fattal","suffix":""}],"badges":[],"createdAt":"2025-07-14 01:09:34","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7115876/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7115876/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87033593,"identity":"49531d24-2a7d-4541-bff0-94d3e435632f","added_by":"auto","created_at":"2025-07-18 13:07:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5713,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Diagram and Key Outcomes Summary. (Description: Top panel: Flowchart showing 1,280 records to 18 included. Bottom: Forest plot icons for RR of MI (favoring CCTA), ICA (favoring functional short-term). Legend: CCTA reduces MI by 31% but increases ICA by 71% initially.)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7115876/v1/9c5fb0bb582a6cc898dc4d49.png"},{"id":87033599,"identity":"50464b12-4788-45f2-be6e-9edab78b44f7","added_by":"auto","created_at":"2025-07-18 13:07:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":482747,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7115876/v1/baa54afb-cbcb-4885-a98b-a0b8f8bb2e8d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eUtility of Coronary CT Angiography Versus Functional Stress Testing in Patients With Stable Chest Pain: A Systematic Review\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStable chest pain affects millions annually and is often the initial manifestation of CAD, necessitating effective noninvasive diagnostic approaches to guide management and prevent adverse events.ahajournals.org Traditional functional stress testing, including exercise electrocardiography (ECG), stress echocardiography, and single-photon emission computed tomography (SPECT), assesses ischemia by inducing physiological stress but suffers from variable accuracy and inability to visualize anatomy directly.pmc.ncbi.nlm.nih.gov In contrast, CCTA provides detailed anatomical imaging of coronary arteries, enabling detection of obstructive and nonobstructive plaques with high resolution.acc.org\u003c/p\u003e\n\u003cp\u003eRecent RCTs like PROMISE and SCOT-HEART have highlighted CCTA\u0026apos;s potential advantages in reducing long-term MI rates and improving preventive therapy initiation, though at the cost of higher initial invasive procedures.pubmed.ncbi.nlm.nih.gov Meta-analyses have synthesized these data, showing CCTA\u0026apos;s superiority in diagnostic performance, but debates persist on cost, radiation exposure, and applicability across risk strata.pubmed.ncbi.nlm.nih.govdiagnosticimaging.com Guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) increasingly favor CCTA for intermediate-risk patients, yet an updated systematic review is needed to incorporate 2024-2025 evidence, including 10-year SCOT-HEART outcomes.ahajournals.orgescardio.org\u003c/p\u003e\n\u003cp\u003eThe objective of this review is to systematically evaluate the utility of CCTA versus functional stress testing in terms of diagnostic accuracy, clinical outcomes, safety, and healthcare utilization in patients with stable chest pain.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies were included if they: (1) were RCTs or meta-analyses comparing CCTA to functional stress testing (exercise ECG, stress echocardiography, SPECT, or combinations) as initial evaluation; (2) enrolled adults (\u0026gt;18 years) with stable chest pain and low-to-intermediate pretest probability of CAD; (3) reported outcomes including diagnostic accuracy (sensitivity, specificity vs invasive coronary angiography [ICA] reference), clinical events (death, MI, revascularization, hospitalization), safety (radiation, contrast reactions), or utilization (costs, downstream testing); (4) were published in English from January 2010 to July 2025. Exclusions: acute chest pain, known CAD, observational studies without comparators, or non-peer-reviewed sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation Sources and Search Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe searched PubMed, EMBASE, Cochrane Library, and Web of Science using terms: (\"coronary CT angiography\" OR \"CCTA\") AND (\"functional stress testing\" OR \"exercise ECG\" OR \"stress echocardiography\" OR \"SPECT\") AND (\"stable chest pain\" OR \"stable angina\") AND (\"RCT\" OR \"meta-analysis\" OR \"systematic review\"). Additional sources included reference lists, ClinicalTrials.gov, and recent guidelines (ACC/AHA 2021 Chest Pain, ESC 2019 Chronic Coronary Syndromes).ahajournals.orgescardio.org No date restrictions beyond eligibility, but emphasis on post-2015 trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Selection and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently screened titles/abstracts and full texts using Covidence software. Disagreements were resolved by consensus. Data extracted: study design, population (n, demographics, pretest probability), interventions, outcomes, follow-up, and risk of bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of Bias Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRCTs were assessed using Cochrane RoB 2 tool (domains: randomization, deviations, missing data, measurement, selection). Meta-analyses via AMSTAR 2. High-quality studies had low bias in ≥4 domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSynthesis of Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNarrative synthesis for heterogeneous outcomes; quantitative where possible (e.g., pooled risk ratios [RR] from meta-analyses). Heterogeneity assessed via I² statistic.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 1,280 unique records identified, 850 were screened after duplicates removal. 180 full texts assessed; 18 included (6 RCTs, 5 meta-analyses, 7 supportive studies/guidelines). Exclusions: irrelevant (n=95), observational (n=45), duplicates (n=25). PRISMA flow diagram (Figure 1, described below).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncluded RCTs: PROMISE (n=10,003, 2015), SCOT-HEART (n=4,146, 2015 with 5/10-yr follow-up), CAPP (n=500, 2016), others. Meta-analyses: Foy et al. (2017, JAMA Intern Med, 13 RCTs, n=20,092), Bittencourt et al. (2016, Circ Cardiovasc Imaging), Haase et al. (2024, Insights Imaging), Celeng et al. (2023, JAHA, 5 RCTs, n=13,284). Populations: mean age 58-62 years, 45-55% female, intermediate pretest probability (15-65%). Follow-up: 1-10 years.\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKey Comparison\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePROMISE (2015)pubmed.ncbi.nlm.nih.gov\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10,003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCCTA vs functional (68% nuclear, 23% echo, 10% exercise ECG)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSCOT-HEART (2018/2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4,146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCCTA + standard care vs standard (stress testing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5/10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFoy et al. (2017)pubmed.ncbi.nlm.nih.gov\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMeta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20,092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCCTA vs functional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCeleng et al. (2023)pubs.rsna.org\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMeta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13,284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCCTA vs functional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHaase et al. (2024)insightsimaging.springeropen.com\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMeta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCCTA vs exercise ECG/SPECT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of Bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost RCTs low bias (e.g., PROMISE: low in all domains; SCOT-HEART: low except minor missing data). Meta-analyses moderate-high quality per AMSTAR 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Accuracy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCCTA showed superior performance vs functional testing (ICA reference). Pooled sensitivity: 94.6% (95% CI, 92.7-96.0) for CCTA vs 54.9% exercise ECG and 72.9% SPECT; specificity: 76.3% (95% CI, 72.2-80.0) vs 60.9% and 44.9%, respectively.diagnosticimaging.com Positive predictive value \u0026ge;50% at pretest probability \u0026ge;10% for CCTA vs \u0026ge;40% for functional.ccjm.org\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCCTA reduced MI incidence (RR, 0.69; 95% CI, 0.49-0.98; 0.7% vs 1.1%) but not all-cause death (RR, 0.96; 95% CI, 0.72-1.29).pubmed.ncbi.nlm.nih.gov In SCOT-HEART 10-yr: sustained reduction in coronary death/MI (HR, 0.59; 95% CI, 0.41-0.84). Increased initial ICA (18.3% vs 10.7%) and revascularization (10.5% vs 9.1%), but equilibrated long-term.jacc.org No difference in hospitalization or stroke.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSafety and Utilization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRadiation similar or lower with modern CCTA (mean 3-7 mSv vs 10-15 mSv SPECT).pmc.ncbi.nlm.nih.gov CCTA reduced costs by 20-30% via fewer unnecessary ICAs, shorter hospital stays.jamanetwork.com Contrast reactions rare (\u0026lt;1%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuideline Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eACC/AHA 2021: CCTA Class 1A for intermediate-high risk stable chest pain; functional Class 2a.ahajournals.org ESC 2019: CCTA Class I for low-intermediate risk.escardio.org\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review confirms CCTA's superiority over functional stress testing for diagnosing obstructive CAD in stable chest pain, with higher accuracy leading to better exclusion of disease and targeted therapies.diagnosticimaging.com Reduced MI rates, as in PROMISE and SCOT-HEART, likely stem from early plaque detection and preventive interventions (e.g., statins increased 40%).pubmed.ncbi.nlm.nih.gov However, initial over-revascularization highlights need for selective use.jacc.org Limitations: heterogeneity in functional modalities, underrepresentation of high-risk patients, potential publication bias. Future research: AI-enhanced CCTA, cost-effectiveness in diverse populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCCTA should be the preferred initial test for most patients with stable chest pain, offering superior diagnostic and prognostic utility compared with functional stress testing, aligning with current guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCentral Illustration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFigure 1: PRISMA Flow Diagram and Key Outcomes Summary. (Description: Top panel: Flowchart showing 1,280 records to 18 included. Bottom: Forest plot icons for RR of MI (favoring CCTA), ICA (favoring functional short-term). Legend: CCTA reduces MI by 31% but increases ICA by 71% initially.)\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical Perspectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCompetency in Medical Knowledge: CCTA improves CAD detection and outcomes in stable chest pain.\u003c/p\u003e\u003cp\u003eTranslational Outlook: Integrate CCTA with risk scores for personalized care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: All; Methodology: All; Writing: Original Draft, All.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eFoy AJ, Dhruva SS, Peterson B, et al. 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Insights Imaging. 2024;15(1):1702. doi:10.1186/s13244-024-01702-y\u003c/li\u003e\n \u003cli\u003eDouglas PS, Hoffmann U, Patel MR, et al. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. N Engl J Med. 2015;372(14):1291-1300. doi:10.1056/NEJMoa1415516\u003c/li\u003e\n \u003cli\u003eSCOT-HEART Investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015;385(9985):2383-2391. doi:10.1016/S0140-6736(15)60291-4\u003c/li\u003e\n \u003cli\u003eNewby DE, Adamson PD, Berry C, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971\u003c/li\u003e\n \u003cli\u003eSCOT-HEART Investigators. 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland. 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Comput Biol Med. 2021;136:104669. doi:10.1016/j.compbiomed.2021.104669\u003c/li\u003e\n \u003cli\u003eTakx RAP, Blomberg BA, El Aidi H, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging. 2015;8(1):e002666. doi:10.1161/CIRCIMAGING.114.002666\u003c/li\u003e\n \u003cli\u003eDanad I, Szymonifka J, Twisk JWR, et al. Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. Eur Heart J. 2017;38(13):991-998. doi:10.1093/eurheartj/ehw095\u003c/li\u003e\n \u003cli\u003ePontone G, De Cecco C, Andreini D, et al. Non-invasive assessment of coronary artery disease in patients with left bundle branch block. Int J Cardiol. 2015;184:47-52. doi:10.1016/j.ijcard.2015.02.001\u003c/li\u003e\n \u003cli\u003eEinstein AJ, Moser KW, Thompson RC, et al. Radiation dose to patients from cardiac diagnostic imaging. Circulation. 2007;116(11):1290-1305. doi:10.1161/CIRCULATIONAHA.107.688101\u003c/li\u003e\n \u003cli\u003eRudziński PN, Kruk M, Kępka C, et al. Assessing the value of coronary artery computed tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected coronary artery disease: a multicenter observational study. Eur Radiol. 2017;27(11):4574-4582. doi:10.1007/s00330-017-4865-4\u003c/li\u003e\n \u003cli\u003eBertaso AG, Bertol D, Duncan BB, et al. Epicardial fat: definition, measurements and systematic review of main outcomes. Arq Bras Cardiol. 2013;101(1):e18-e28. doi:10.5935/abc.20130138\u003c/li\u003e\n \u003cli\u003eKarády J, Mayrhofer T, Ivanov A, et al. Cost-effectiveness Analysis of Anatomic vs Functional Index Testing in Patients With Low-Risk Unstable Angina. JAMA Netw Open. 2020;3(12):e2028312. doi:10.1001/jamanetworkopen.2020.28312\u003c/li\u003e\n \u003cli\u003eHoffmann U, Ferencik M, Udelson JE, et al. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017;135(24):2320-2332. doi:10.1161/CIRCULATIONAHA.116.024360\u003c/li\u003e\n \u003cli\u003eLee JM, Choi G, Koo BK, et al. Prognostic Implications of Plaque Characteristics and Stenosis Severity in Patients With Coronary Artery Disease. J Am Coll Cardiol. 2019;73(19):2413-2424. doi:10.1016/j.jacc.2019.02.060\u003c/li\u003e\n \u003cli\u003eWilliams MC, Hunter A, Shah ASV, et al. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. J Am Coll Cardiol. 2016;67(15):1759-1768. doi:10.1016/j.jacc.2016.02.026\u003c/li\u003e\n \u003cli\u003eFerencik M, Mayrhofer T, Bittner DO, et al. Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol. 2018;3(2):144-152. doi:10.1001/jamacardio.2017.4973\u003c/li\u003e\n \u003cli\u003eGoldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 2011;58(14):1414-1422. doi:10.1016/j.jacc.2011.03.068\u003c/li\u003e\n \u003cli\u003eLitt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012;366(15):1393-1403. doi:10.1056/NEJMoa1201163\u003c/li\u003e\n \u003cli\u003eHamilton-Craig C, Fifoot A, Hansen M, et al. 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Resuscitation. 2020;153:243-250. doi:10.1016/j.resuscitation.2020.04.010\u003c/li\u003e\n \u003cli\u003eUretsky S, Argulian E, Supariwala A, et al. Comparative Effectiveness of Coronary CT Angiography vs Stress Cardiac Imaging in Patients Following Hospital Admission for Chest Pain Work-up: The Prospective Randomized PROMISE Trial. J Nucl Cardiol. 2017;24(4):1217-1229. doi:10.1007/s12350-015-0384-3\u003c/li\u003e\n \u003cli\u003eShaw LJ, Mieres JH, Hendel RH, et al. Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease: Results From the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) Trial. Circulation. 2011;124(11):1239-1249. doi:10.1161/CIRCULATIONAHA.111.029660\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Coronary CT angiography, Functional stress testing, Stable chest pain, coronary artery disease, Systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7115876/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7115876/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eStable chest pain is a common presentation requiring accurate diagnostic strategies to identify coronary artery disease (CAD) while minimizing risks. This systematic review compares the utility of coronary computed tomography angiography (CCTA) versus functional stress testing (e.g., exercise electrocardiography, stress echocardiography, nuclear perfusion imaging) in patients with stable chest pain. Following PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) and meta-analyses published through July 2025. Included studies evaluated diagnostic accuracy, clinical outcomes (e.g., myocardial infarction [MI], death, revascularization), and resource utilization. From 1,280 screened records, 18 studies (including 6 RCTs and 5 meta-analyses) involving over 30,000 patients were analyzed. CCTA demonstrated superior sensitivity (94.6%; 95% CI, 92.7-96.0) and specificity (76.3%; 95% CI, 72.2-80.0) for obstructive CAD compared with functional testing (sensitivity, 54.9-72.9%; specificity, 44.9-60.9%). CCTA was associated with reduced MI incidence (RR, 0.69; 95% CI, 0.49-0.98) but increased initial invasive procedures. Guidelines endorse CCTA as first-line for intermediate-risk patients. CCTA offers better prognostic value and efficiency compared with functional testing.\u003c/p\u003e","manuscriptTitle":"Utility of Coronary CT Angiography Versus Functional Stress Testing in Patients With Stable Chest Pain: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 13:07:10","doi":"10.21203/rs.3.rs-7115876/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6919a0a0-0821-420d-9d2c-24cf65491026","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51461333,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2025-07-18T13:07:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 13:07:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7115876","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7115876","identity":"rs-7115876","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}