Coronary CT angiography as an ‘one-stop shop’ to detect the high-risk plaque and the vulnerable patient

This editorial refers to ‘Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial’, by N. Curzen et al., doi:10.1093/eurheartj/ehab444. First devised as an invasive measurement of the clinical relevance of coronary artery stenosis, fractional flow reserve (FFR) has become widely utilized for identifying coronary lesions in need of revascularization at the time of invasive coronary angiography (ICA).1 European guidelines recommend pressure wire-based FFR or instantaneous wave-free ratio measurements before revascularization, especially when prior testing for myocardial ischaemia is either inconclusive or unavailable.2 Indeed, FFR is the gold standard test to tell us whether a coronary atherosclerotic lesion is haemodynamically significant. This is achieved by measuring the ratio of the coronary artery pressure distal to the lesion divided by the coronary pressure proximal to the lesion (or at the aortic root), under maximal hyperaemic...