Coronary computed tomography angiography is the new reference standard for the diagnosis of coronary artery disease: pros and cons

Accurate and timely diagnosis is essential in patients with suspected coronary artery disease (CAD). Traditionally, invasive coronary angiography (ICA) has been the gold standard for CAD detection, but coronary computed tomography angiography (CCTA) is rapidly emerging as a non-invasive alternative. Indeed, CCTA offers important advantages, as it avoids procedural risks (e.g., bleeding) while providing detailed information on coronary anatomy, subclinical atherosclerosis and plaque morphology. In particular, clinical trials have shown that CCTA has a high negative predictive value, resulting in it being particularly appealing to rule out the diagnosis of CAD in patients at low-to-intermediate risk. However, CCTA is not without limitations, especially in patients with extensive coronary calcification, irregular heart rhythm, or renal impairment. Despite the accruing evidence on the role of CCTA and its expanding use in clinical practice, the question remains whether it should replace ICA as the standard diagnostic tool in patients with suspected CAD.

Pros

Marc Dewey, MD; Federico Biavati, MD

CAD remains the leading cause of death worldwide. CCTA has emerged as a non-invasive alternative to diagnose CAD, competing with traditional invasive methods...