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We assessed associations between pre-test probability, 5-year coronary heart disease death or non-fatal myocardial infarction and study intervention (standard care vs. CTCA). The study population consisted of 3755 patients (30\u201375\u2009years, 46% women) with a median pre-test probability of 11% of whom 1622 (43%) had a pre-test probability of &amp;gt;15%. In those who underwent CTCA (n\u2009=\u20091613), the prevalence of obstructive disease was 22%. When divided into deciles of pre-test probability, the observed disease prevalence was similar but higher than the corresponding median pre-test probability [median difference 2.3 (1.3\u20135.6)%]. There were more clinical events in patients with a pre-test probability &amp;gt;15% compared to those at 5\u201315% and &amp;lt;5% (4.1%, 1.5%, and 1.4%, respectively, P\u2009&amp;lt;\u20090.001). Across the total cohort, fewer clinical events occurred in patients who underwent CTCA, with the greatest difference in those with a pre-test probability &amp;gt;15% (2.8% vs. 5.3%, log rank P\u2009=\u20090.01), although this interaction was not statistically significant on multivariable modelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion\u2003<\/jats:title>\n                    <jats:p>The updated 2019 ESC guideline pre-test probability recommendations tended to slightly underestimate disease prevalence in our cohort. Pre-test probability is a powerful predictor of future coronary events and helps select those who may derive the greatest absolute benefit from CTCA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaa006","type":"journal-article","created":{"date-parts":[[2020,1,16]],"date-time":"2020-01-16T15:10:27Z","timestamp":1579187427000},"page":"293-300","source":"Crossref","is-referenced-by-count":43,"title":["Validation of European Society of Cardiology pre-test probabilities for obstructive coronary artery disease in suspected stable angina"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-4906","authenticated-orcid":false,"given":"Rong","family":"Bing","sequence":"first","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trisha","family":"Singh","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R","family":"Dweck","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L","family":"Mills","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"},{"name":"Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 9 Little France Road, Edinburgh EH16 4UX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3556-2428","authenticated-orcid":false,"given":"Michelle C","family":"Williams","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D","family":"Adamson","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK"},{"name":"Christchurch Heart Institute, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Newby","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, 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