Multislice computed tomography CAG has emerged rapidly because of rapid improvement in imaging technology as a sensitive diagnostic tool. The 16-slice generation of MSCT-CAG demonstrated highly accurate qualitative identification of significant (>50%) coronary artery stenosis in vessels larger than 1.5 to 2.0 mm, with reported sensitivities, specificities, and positive and negative predictive values ranging from 82% to 95%, 82% to 98%, 79% to 83%, and 98% to 99%, respectively.2,5,10- 13 In a meta-analysis by Schuijf et al,14 of 24 studies totaling 1300 patients, the overall sensitivity, specificity, and positive and negative predictive values of MSCT-CAG (4-16 slices) were 85% (95% CI, 83%-87%), 95% (95% CI, 93%-95%), 76% (95% CI, 74%-78%), and 97% (95% CI, 97%), respectively. The newest-generation 64-slice MSCT-CAG has improved imaging quality, is nearly motion free, and gives isotropic image quality and data acquired during a single breath-hold of about 13 seconds. These improvements have enhanced sensitivity (range, 94%-99%), specificity (range, 95%-97%), and positive predictive value (range, 76%-97%), although the negative predictive value remains unchanged.4,15- 16 The high sensitivity and negative predictive value strongly suggest that MSCT-CAG could be useful in ruling out a diagnosis of CAD. However, to our knowledge, no pragmatic management outcome study validating the safety and usefulness of the procedure has been published. In our study, after a mean of 14.7 months of follow-up, 137 of 141 patients (97.2%) were clinically event free. This value can favorably be compared with the high negative predictive value that was validated by all the previous studies2,4- 5,10- 13,15- 16 comparing MSCT-CAG with C-CAG. Other noninvasive tests also provide prognostic information useful in risk stratification: a normal single-photon emission computed tomographic result has been shown to indicate a good clinical outcome, with an annual death or infarct rate of less than 1% per year17; and exercise echocardiography has a 98.8% negative predictive value for myocardial infarction and cardiac death, with at least 3 months of follow-up.18 These results confirm that MSCT-CAG is useful in the diagnostic workup of patients with suspected significant CAD and can, when the result is normal, safely rule out this diagnosis.