CCTA as a Screening Tool (Invited Commentary)

Abstract Coronary computed tomography angiography (CCTA) has evolved into a key non-invasive tool for evaluating coronary artery disease, offering high sensitivity, detailed anatomical visualization, and strong prognostic value. Current Society of Cardiovascular Computed Tomography guidelines recommend CCTA as a first-line test for symptomatic patients, while limiting its use in asymptomatic individuals to select high-risk cases. Advantages in a screening context include early detection of subclinical atherosclerosis, prognostic assessment through high-risk plaque features, and facilitation of personalized preventive strategies. However, widespread screening faces challenges: procedural complexity, contrast and radiation exposure, psychological impact, and economic cost. Emerging integration of artificial intelligence promises to enhance efficiency, automate plaque quantification, and enable individualized risk prediction, potentially improving cost-effectiveness and clinical adoption. Future validation through randomized controlled trials and real-world data is needed to confirm the impact of CCTA-based screening on cardiovascular event reduction, healthcare resource use, and patient quality of life.