Key result
CCTA serves as primary noninvasive gatekeeper for stable chest pain, reserving ICA for high-risk diagnostics.
Why the study?
The diagnostic pathway for CAD is transitioning toward noninvasive risk stratification, requiring clarification of the respective roles and physical limitations of CCTA and ICA in modern cardiovascular care.
What are the respective roles, diagnostic performance, and clinical utility of CCTA versus ICA in the evaluation of coronary artery disease?
What are the respective roles, diagnostic performance, and clinical utility of CCTA versus ICA in the evaluation of coronary artery disease?
This review reinforces the 'CCTA-first' approach for evaluating stable chest pain, highlighting advancements like PCD-CT and FFR-CT that enhance its diagnostic and prognostic capabilities.
INTRODUCTION: The diagnostic pathway for coronary artery disease (CAD) is actively transitioning toward noninvasive risk stratification. This review contrasts Coronary Computed Tomography Angiography (CCTA) with Invasive Coronary Angiography (ICA) to clarify their respective roles and physical limitations in modern cardiovascular care. AREAS COVERED: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus for articles published between January 2015 and March 2026. We evaluate the physical principles, diagnostic performance, and clinical utility of both imaging modalities. The discussion includes recent breakthroughs like Photon-Counting Detector CT (PCD-CT), which improves stenosis grading in heavily calcified lesions. We also explore CCTA's expansion beyond basic morphology into functional and prognostic assessments via CT-derived Fractional Flow Reserve (FFR-CT), artificial intelligence algorithms (AI-QCT), and the Pericoronary Fat Attenuation Index (FAI). EXPERT OPINION: Current clinical evidence supports a 'CCTA-first' approach for stable chest pain. CCTA functions as the primary noninvasive gatekeeper and platform for plaque phenotyping, while ICA remains the irreplaceable standard for high-risk diagnostics and targeted therapeutic revascularization.
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Masri et al. (2026) conducted a review in Coronary artery disease (CAD). Coronary Computed Tomography Angiography (CCTA) vs. Invasive Coronary Angiography (ICA) was evaluated. Coronary Computed Tomography Angiography is supported as the primary noninvasive gatekeeper for stable chest pain, while invasive coronary angiography remains the standard for high-risk diagnostics.
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