Coronary calcium scoring as first-line test to detect and exclude coronary artery disease in GP patients with stable chest pain

INTERVENTION: The design is a pragmatic cluster randomized trial in which direct access to CT calcium scoring is compared to exercise ECG testing in patients with chest discomfort. Randomization will take place at GP level. Patients in both clusters will be asked for consent to fill in questionnaires and for the researchers to gather data on work‐up and follow‐up. CONDITION: coronary artery disease diagnosis general practitioner PRIMARY OUTCOME: To determine the increase in detection / treatment rate of CAD in GP offices with the calcium score‐based strategy, compared to GP offices with the exercise ECG‐based strategy, as measured by number of patients registered for/treated by the CardioVascular Risk factor Management guideline. SECONDARY OUTCOME: Secondary outcomes include individual‐based outcomes such as effectiveness of CAD diagnosis and referral, patient preference for diagnostic testing, and the effect of CT calcium scoring on reduction of MACE INCLUSION CRITERIA: Patients with non‐acute chest discomfort, either atypical AP or aspecific chest pain, with indication for further diagnostic testing as determined by the GP