The PROMISE study (Douglas et al. 2015) is a US‑based multicentre randomised controlled trial involving over 10,000 patients, with a median follow‑up of 25 months. Although the study did not include FFRCT, the EAC considered it relevant to the decision problem because it provides further evidence on a diagnostic pathway based on CCTA. Patients with a mean pre-test likelihood of coronary artery disease of 53.3% plus or minus 21.4% were randomly assigned to either CCTA or functional imaging as a first-line diagnostic test. The composite primary end point was death, myocardial infarction, hospitalisation for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterisation that did not show obstructive coronary artery disease and radiation exposure. Results showed that 164 of 4,996 (3.3%) patients in the CCTA group and in 151 of 5,007 (3.0%) in the functional testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; p=0.75) achieved the primary end point. CCTA was associated with fewer catheterisations showing no obstructive coronary artery disease than functional imaging (3.4% compared with 4.3%, p=0.02), although more patients in the CCTA group had catheterisation within 90 days of randomisation (12.2% compared with 8.1%). The median cumulative radiation exposure per patient was lower in the CCTA group than in the functional testing group (10.0 mSv compared with 11.3 mSv), but 32.6% of the patients in the functional testing group had no exposure. As such, overall exposure was higher in the CCTA group (mean 12.0 mSv compared with 10.1 mSv; p<0.001).