Such a response has considerable economic, social and human costs. Research should be conducted to clarify if an emergency response in all circumstances is appropriate, or if there are identifiable factors such as age, sex or associated symptoms that would allow a modified response and a more appropriate use of resources. 3 Establishing a national registry for people who are undergoing initial assessment for stable angina Can a national registry of people presenting with suspected angina be established to allow cohort analysis of treatments, investigations and outcomes in this group? Such a registry would provide a vital resource for a range of important research projects, including: development and validation of a new score for assessing the pre-test probability of disease, addressing outstanding uncertainties in the estimation of the pre-test probability of CAD based on simple measures made at initial assessment (history, examination, routine bloods, resting 12-lead ECG) assessment of the extent to which new circulating biomarkers add additional information to measures made at initial assessment provision of a framework for trial recruitment without significant work-up bias allowing evaluation of the diagnostic and prognostic test performance of CT-based, MR, echocardiography and radionuclide technologies. Why this is important A national prospective registry of consecutive people with suspected stable angina before initial diagnostic testing does not currently exist in the UK or in any other country. Establishing such a registry would offer the following methodological strengths: statistical size, representative patients without work-up bias, contemporary data. This would overcome key problems in much of the existing evidence base. Accurate assessment of pre-test likelihood of coronary disease is needed to inform the cost-effective choice of investigative technologies such as CT coronary calcium scoring for people with chest pain that may be caused by myocardial ischaemia. 