Background: Detection of coronary artery disease (CAD) is important due to its high prevalence and its medical and economic implications. Purpose: A systematic review of the diagnostic performance of stress echocardiography (Echo), SPECT, cardiac magnetic resonance (CMR), CT Perfusion (CTP) and PET versus invasive coronary angiography (ICA) or fractional flow reserve (FFR) using hierarchical summary ROC (HSROC) methods. Data Sources: MEDLINE, EMBASE and SCOPUS for literature published in English or Spanish from January 1970 to December 2015. Study Selection: For inclusion, studies had to meet the Cochrane guidelines, had to evaluate the sensitivity and specificity methods, and use ICA and/or FFR. Only those studies with STARD methodology ≥60% were included. Data Extraction: Ten investigators extracted patient and study characteristics and 4 resolved any disagreements.