Abstract: Objective　In view of different risk stratification and diagnostic strategies for patients with stable chest pain, coronary computed tomographic angiography (CCTA) was used to verify and compare the advantages and disadvantages of the risk stratification and diagnostic strategies guided by the 2016 NICE and 2019 ESC guidelines. Methods　A total of 1 021 patients with stable chest pain who underwent CCTA were collected in Tianjin Chest Hospital from January 2017 to January 2020. According to the risk stratification strategy of NICE and ESC guidelines, the patients were divided into low risk group and high risk group. Coronary artery disease (CAD) was defined as stenosis≥50% in diameter at least one segment of the coronary artery by CCTA. The risk stratification and diagnosis strategies of the guidelines were verified and compared by using area under the receiver operating characteristic curve (AUC) and the net reclassification improvement (NRI). Results　Overall, 212 patients were diagnosed as CAD by coronary CCTA examination. Among the different risk stratification groups of ESC and NICE, patients in the high risk group were more likely to develop coronary heart disease than those of the low risk group (NICE: 25.62 % vs. 7.69%, χ2=41.866, P＜0.01; ESC: 45.06% vs. 3.47%, χ2=262.450, P＜0.01). The risk stratification strategy of ESC was improved compared with that of NICE, and which has better classification capabilities (NRI=38.54%, P＜0.01). The ESC guideline predicted that the AUC of coronary heart disease was 0.837 (95%CI: 0.813-0.860). The expected prevalence of coronary heart disease based on the ESC guideline greatly underestimated the observed prevalence (14.63% vs. 20.76%, χ2=13.349, P＜0.01), and this difference also existed in male patients (21.25% vs. 32.15%, χ2=13.580, P＜0.01). There was no significant difference in female patients (9.39% vs. 11.75%，χ2=1.561，P＞0.05). Conclusion　The ESC guideline for stable chest pain is better than that of NICE in the risk strategy of stable chest pain. The diagnostic strategy of ESC guideline has a good diagnostic value for coronary heart disease, but it underestimates the actual prevalence rate.

Key words: coronary disease, coronary angiographycoronary, computed tomography angiography, ROC curve, stable chest pain, risk stratification, diagnostic strategy