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those with a higher clinical likelihood of obstructive CAD (i.e. based on cardiovascular risk factors, typical angina, male sex, positive exercise ECG) were frequently directly referred to ICA without a previous imaging test

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac640/6855562?login=false#.Y4lbE6jF2_o.twitter