[Coronary CT angiography: Diagnosis, prognosis and PCI planning].

Abstract

Coronary CT angiography (CCTA), long confined to a diagnostic triage role, now occupies a central place at every stage of coronary artery disease management. Diagnostically, it overcomes the limitations of the calcium score - blind to non-calcified plaque - by directly visualizing the arterial wall, and now integrates functional assessment through CT-derived fractional flow reserve. Prognostically, overall atherosclerotic burden and plaque morphology (high-risk plaque, pericoronary fat) prove more predictive of cardiovascular events than stenosis severity alone, a finding that led to the revision of the CAD-RADS classification. Therapeutically, CCTA enables detailed planning of percutaneous coronary intervention - guiding catheter selection, anticipating calcium modification needs, and determining stent length - foreshadowing the concept of CT-guided PCI. This trajectory reflects a broader paradigm shift in cardiology, from ischaemia to atheroma. Upcoming technical developments (photon-counting CT, myocardial perfusion) are expected to further consolidate CCTA's central role in interventional coronary cardiology.