Cardiovascular disease is the leading cause of mortality for women in the U.S. Coronary heart disease-which includes coronary artery (or atherosclerotic) disease (CAD), myocardial infarction (MI), acute coronary syndromes, and angina-is the largest subset of this mortality. According to the American Heart Association (AHA), approximately one in three female adults has some form of cardiovascular disease. It is estimated that 8.1 million women alive today have a history of heart attack, angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle), or both, and experts predict that in 2010 alone an estimated 370,000 women will have a new or recurrent MI. Overall, women who have had an acute MI-particularly those older than 55 years of age-have a worse prognosis than men, with a greater recurrence of MI and higher mortality. More women (5.5 million) than men (4.3 million) have angina in total numbers. However, the prevalence of CAD in women with chest pain is about 50%, compared with 80% in men, which complicates diagnosis in women. The AHA suggests there is evidence showing that women at risk for CAD are less often referred for the appropriate diagnostic test than are men. Coronary anatomy and pathology have traditionally been defined and identified by invasive, catheter-based x-ray angiography, also referred to as coronary angiography. The major benefits of invasive coronary angiography over noninvasive techniques are that the use of a catheter makes it possible to see the coronary arteries with greater anatomic precision and resolution and to combine diagnosis and treatment in a single procedure. The limitations of the procedure include the invasive nature of the test and the limited data on the functional impact of a luminal obstruction. These limitations are generally considered to be minor when compared with the benefits of the procedure, and coronary angiography is now the reference (gold) standard for clinical care of patients who have chest pain suggestive of CAD. Coronary angiography, however, is not risk-free. Coronary angiography is generally indicated in patients who have chest pain and are at high risk for CAD. The goal of this comparative effectiveness report was to conduct a systematic review of the peer-reviewed medical literature assessing (1) the accuracy of different NITs for diagnosing CAD in women with symptoms suspicious of CAD, (2) the predictors affecting test accuracy, (3) the ability to provide risk stratification and prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes, and (4) the safety concerns and risks to women undergoing these tests. The following Key Questions (KQs) were considered in this review: KQ1. What is the accuracy of one NIT in diagnosing obstructive and nonobstructive CAD when compared with another NIT or with coronary angiography in women with symptoms suspicious for CAD? KQ2. What are the predictors of diagnostic accuracy (e.g., age, race/ethnicity, body size, heart size, menopausal status, functional status, stress modality) of different NITs in women? KQ3. Is there evidence that the use of NITs (when compared with other NITs or with coronary angiography) in women improves: KQ3a. Risk stratification/prognostic information? KQ3b. Decisionmaking regarding treatment options (e.g., revascularization, optimal medical therapy)? KQ3c. Clinical outcomes (e.g., death, myocardial infarction, unstable angina, hospitalization, revascularization, angina relief, quality of life)? KQ4. Are there significant safety concerns/risks (i.e., radiation exposure, access site complications, contrast agent-induced nephropathy, nephrogenic systemic fibrosis, anaphylaxis, arrhythmias) associated with the use of different NITs to diagnose CAD in women with symptoms suspicious for CAD?