Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review.

Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Computed tomography coronary anatomy with functionality assessment could potentially become a first line in diagnosis. Noninvasive imaging assessment of plaque burden and morphology is becoming a valuable substitute for intravascular imaging. Recently, wall shear stress and perivascular inflammation have been introduced. These assessments could support risk management for both primary and secondary cardiovascular prevention. Anatomy, functionality, and plaque composition by CTA tend to replace invasive assessment. Complete CTA assessment could provide a 1-stop-shop for diagnosis, risk management, and decision-making on treatment.

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Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Funding Support and Author Disclosures Dr Serruys has received personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside of the submitted work. Dr Hara has received a grant for studying overseas from Japanese Circulation Society, a grant-in-Aid for JSPS Fellows, and a grant from Fukuda Foundation for Medical Technology. Dr Nørgaard has received unrestricted research support from HeartFlow Inc. Dr Knuuti has received consultancy fees from GE Healthcare and AstraZeneca; and has received speaker fees from GE Healthcare, Bayer, Lundbeck, Boehringer Ingelheim, and Merck, outside of the submitted work. Dr Nieman has received unrestricted institutional research support from Siemens Healthineers, Bayer, and HeartFlow Inc; and has served as a consultant for Siemens Medical Solutions USA. Dr Leipsic has served as a consultant to and holds stock options in HeartFlow and Circle CVI; and has served on the Speakers Bureau of GE Healthcare and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.