《Table 1 Summary of landmark international and Australia coronary artery disease studies》

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《Risk stratification for coronary artery disease in multi-ethnic populations:Are there broader considerations for cost efficiency》

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Common denominators in risk exist.Socioeconomic status and ethnography can contribute to this risk and needs to be factored in future risk scores.ATSI:Aboriginal and Torres Strait Islander；ET:Epidemiological transition；RF:Risk factors.*FHS:Framingham Hear

Imaging modalities，Ca Score and computer tomography coronary angiography（CTCA）:When deciding on the imaging modality several factors have to be considered，including:availability，accessibility，reproducibility，cost and safety（Table2）.ECG based exercise stress testing remains first line for younger males with low risk that are able to exercise.Direct referrals for stress echocardiography is debated presently，but evidence points to superior cost efficacy when using a patient centric approach[60，61].Much of the exercise and imaging quality deficits can be overcome by pharmacological agents e.g.，dobutamine and contrast agents[60].Appropriateremuneration strategies for this have not been factored outside tertiary centers.The main advantages appear to be access，accuracy，reproducibility and cost.The access may also be the Achilles heel for cost efficacy as guidelines for repeat testing are not well regulated.SPECT has equivalent accuracy but falls short in other parameters.A main advantage could be in those patients with baseline resting wall motion abnormalities，to quantitate location and size of infarct and obtain a gated blood pool scan ejection fraction.Cardiac MRI is safe and accurate but has other access and cost issues of SPECT.With existing dilated cardiomyopathies we suggest a baseline ESE for functional assessment combined with a baseline MRI or GBPS ejection fraction.Should an MRI be available，combination with cardiac CTCA without additional functional assessment，could be considered[61].