The study participants were symptomatic outpatients without diagnosed CAD whose physicians believed that nonurgent, noninvasive cardiovascular testing was necessary for the evaluation of suspected CAD. Additional inclusion criteria were an age of more than 54 years (in men) or more than 64 years (in women) or an age of 45 to 54 years (in men) or 50 to 64 years (in women) with at least one cardiac risk factor (diabetes, peripheral arterial disease, cerebrovascular disease, current or past tobacco use, hypertension, or dyslipidemia). Exclusion criteria were an unstable hemodynamic status or arrhythmias that required urgent evaluation for suspected acute coronary syndrome, a history of CAD or evaluation for CAD within the previous 12 months, or clinically significant congenital, valvular, or cardiomyopathic heart disease, or any reason that the patient could not be randomly assigned to either group safely (Table S1 in the Supplementary Appendix, available at NEJM.org).