Coronary computed tomography angiography in coronary heart disease: clinical applications and limitations

Coronary computed tomography angiography (CCTA) is increasingly being used to assess patients with stable coronary artery disease (CAD) at low-intermediate risk because it has high sensitivity, specificity and negative predictive value for the detection of CAD. Technological advancements in the quantification and functional assessment of epicardial coronary stenosis by means of fractional flow reserve derived from computed tomography (FFRCT) have raised the possibility of expanding CCTA use to guide decision-making regarding revascularization strategies in CAD patients. Recent data have shown that initial diagnostic evaluation of coronary anatomy by CCTA vs standard of care in patients with suspected CAD is associated with lower rates of cardiac death or nonfatal myocardial infarction without long-term use of coronary angiography or coronary revascularization, suggesting a prognostic value of anatomic assessment in patients with suspected CAD. Good quality images are needed for reliable interpretations and results. Radiation exposure is still a concern.