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Background

ASSIST (Anatomical vs. Stress teSting decIsion Support Tool) is an RCT-derived ML-based tool to guide anatomical vs functional testing for suspected coronary artery disease (CAD). Whether real-world practice aligns with personalized strategy requires evaluation.

Methods

We identified 134,675 individuals from (i) US-based health system (Yale-New Haven Health EHR) who underwent functional-first (n= 130,643, 97.0%) vs anatomical-first testing (n= 4,032, 3.0%) during 2013-2023, and (ii) 3,903 UK-Biobank (UKB) participants referred for anatomical (n= 581, 14.9%) vs functional testing (n= 3322, 85.1%). We assessed the adjusted association between ASSIST-concordant management and cross-sectional characteristics, as well as the future risk of death/myocardial infarction.

Results

A total of 107,810 (80.1%) EHR and 2,610 (66.9%) UKB participants had ASSIST-concordant management. Younger …