The prevalence of angina is high in the general population, and increases with age in both sexes. Little consensus exists about which test is preferable when one is required for diagnosis, including significant differences in the current US and European guidelines. However, the recent PROMISE and SCOT-HEART trials incorporating the use of CCTA have demonstrated that an anatomical strategy is a reasonable alternative initial approach to use in intermediate-risk patients with stable chest for the diagnosis of IHD. Contemporary approaches should therefore consider both functional and anatomical strategies in an integrated decision-making model.