PRECISE Trial: Rationale and Design for a Precision Diagnostic Strategy in Stable Chest Pain

The PRECISE trial design article described a strategy for evaluating stable chest pain patients using a precision approach: deferred initial testing in very low-risk individuals, with selective coronary CT angiography and CT-derived fractional flow reserve (FFRCT) reserved for those at intermediate or higher pre-test probability.

The trial tests whether this selective, precision-guided diagnostic strategy produces better clinical outcomes and fewer unnecessary downstream procedures than usual care — including traditional functional stress testing. The enrolled population includes patients with stable symptoms across the risk spectrum, with results pending at the time of publication.

The clinical significance of the PRECISE trial, if positive, would be substantial. It directly challenges the default of routine functional stress testing in stable chest pain patients, instead proposing anatomical CCTA plus physiological FFRCT as a targeted alternative. The design reflects lessons from ISCHEMIA and PROMISE trials about the limits of ischemia-based triage.

We rate the evidence limited — a design paper reporting rationale, not results. The clinical significance reflects the importance of the question being tested, which is central to the optimal diagnostic workup of stable chest pain.