Examining the Association between Cardiovascular Outcomes in Individuals Undergoing Percutaneous Coronary Intervention with or without a Preceding Coronary CT Angiogram

Background The role of coronary CT angiography (CCTA) in improving outcomes among patients undergoing percutaneous coronary intervention (PCI) for obstructive coronary artery disease (CAD) remains unclear. Methods A retrospective cohort study using the TriNetX U.S. Research Network identified adults (≥18 years) who underwent de novo PCI (2013-2025). Patients with prior or presenting PCI, CABG, or acute coronary syndrome were excluded. Those with CCTA within 1 year before PCI were compared to those without. After 1:1 propensity score matching, 4,936 patients remained per group. The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), or heart failure (HF) at 1 and 5 years. Results Baseline characteristics were well balanced post-matching. CCTA prior to PCI was associated with lower rates of the composite outcome at 1 year (9.6% vs 13.0%; HR 0.74, 95% CI 0.66-0.83) and 5 years (16.1% vs 23.7%; HR 0.79, 95% CI 0.72-0.86). Reductions were mainly driven by lower MI and mortality rates. HF showed no difference at 1 year but was significantly lower at 5 years (HR 0.85, 95% CI 0.76-0.95). Conclusions Pre-procedural CCTA within one year of PCI was associated with improved cardiovascular outcomes at 1 and 5 years, suggesting potential benefits from enhanced anatomical assessment and medical optimization before revascularization.