**exercise stress test** - *pro*: prognostically useful, predicts risk of adverse cardiac events in 6 mo following ED presentation  - *con*: poor sensitivity and specificity for ACS.  does not reliabily rule in or out ACS **CTCA** - *pro*: high sensitivity and specificity for coronary artery obstruction ~90% - *con*: prognostically unhelpful, as just because there is coronary stenosis does not predict adverse outcomes in the future