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Background CT coronary angiography (CTCA) is widely used to rule out coronary artery disease (CAD) in patients with chest pain. However, guidelines recommend that in patients with high probability of having CAD, alternative tests should be considered.Aim To study the nature of requests and the outcomes of patients undergoing CTCA at our institution.Methods Retrospective analysis of all patients who had undergone a CTCA at our institution between January and December 2023. Pretest probability of having CAD was calculated according to the European Society of Cardiology guidelines on the management of Chronic coronary syndromes. 1 Results Data from 1089 (mean age 55.4+11.9 years; 533 (48.9%) male patients were analysed. Chest pain (84.3%) was the main presenting complaint with 57.2% of these having atypical pains and 27.2% having typical chest pains. The other indications were palpitations/arrhythmias (11.7%) and breathlessness (20.8%). The pretest probability of CAD was low, moderate or high, in 38.3%, 24.9% and 35.9% patients respectively. Majority of the patients had either normal (50.6%) or mild disease (32.1%), with the remaining having either moderate or severe disease. Even among patients with a high pretest probability of CAD, 78.7% had normal or mild atheroma. The majority of patients (87.6%) were either reassured or started on medications while 99 (9.1%) were referred for an angiogram and 37 for a functional test (3.4%) ( table 1). Of those who were referred for an angiogram, 21 had undergone PCI (21.2%), another 21 (21.2%) had undergone CABG and the remaining 57 (57.5%) were started on medical management.Abstract P26 Table 1Outcomes of CT coronary angiography based on the pretest probability of having coronary artery disease Normal/Mild CAD Moderate CAD Severe CAD Low pretest probability (383) 366 (95.5%) 10 (2.6%) 7 (1.8%) Medium pretest probability (258) 235 (91.1%) 14 (5.4%) 9 (3.4%) High pretest probability (357) 281 (78.7%) 32 (8.9%) 44 (12.3%) CAD- coronary artery diseaseConclusions CTCA is a valuable non-invasive tool in ruling out significant CAD and helps us to better triage patients for invasive testing and appears to be appropriately used at our institution. Current methods of assessing pretest clinical likelihood are over-estimating risk but this leads to increased sensitivity of the assessment.