On Demand: Maximizing the Impact of Cardiac CT Across Clinical and Operational Workflows-Presentation Slides

Presentation Slides

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This document synthesizes the evolving integration of Cardiac Computed Tomography Angiography (CCTA) in clinical cardiology, particularly for diagnosis, risk stratification, and guiding interventions in coronary artery disease (CAD). Updated 2021 chest pain guidelines elevate CCTA as the only Class 1, Level A evidence noninvasive test for intermediate to high-risk stable chest pain patients without known CAD, highlighting its diagnostic and treatment guidance superiority over traditional stress testing.<br /><br />The PRECISE trial demonstrated that a diagnostic pathway incorporating CCTA with selective fractional flow reserve computed tomography (FFRCT) significantly improves detection of patients requiring revascularization, reduces false positives and unnecessary invasive angiographies, and reduces major events compared to traditional functional testing. Cone Health’s implementation confirms higher revascularization yield with CCTA/FFRCT.<br /><br />Advanced AI-driven coronary plaque analysis enhances risk prediction beyond calcium scoring by differentiating plaque types and volumes, allowing precision prevention strategies tailored to plaque burden and biomarker thresholds. Successful CCTA programs require multidisciplinary collaboration involving trained cardiologists, nurses, and technologists, appropriate scanner technology for efficient single-beat image acquisition with motion correction, and optimized operational workflows.<br /><br />In parallel, CCTA's role is expanding into pre-procedural planning for percutaneous coronary intervention (PCI), as endorsed by the 2025 SCAI/SCCT expert roundtable. CCTA-guided PCI improves procedural success, reduces complications, contrast usage, radiation exposure, and procedural time, facilitated by tools like FFRCT virtual planners that help optimize stent length, positioning, and guide catheter selection. Trials support CCTA guidance in complex scenarios such as chronic total occlusions. Techniques like CT and fluoroscopy co-registration and emerging 3D plaque modeling further advance CT-guided PCI towards a comprehensive, image-guided interventional strategy.<br /><br />Overall, the convergence of high-quality cardiac CT imaging, AI-enhanced plaque quantification, FFRCT physiology assessment, and integration with interventional cardiology is transforming chest pain evaluation and coronary interventions, advocating for institutional investment in training, technology, and workflow for optimal patient outcomes.

Keywords

Cardiac Computed Tomography Angiography

CCTA

Coronary Artery Disease

Chest Pain Guidelines 2021

PRECISE Trial

Fractional Flow Reserve Computed Tomography

FFRCT

AI-driven Coronary Plaque Analysis

Percutaneous Coronary Intervention

CT-guided PCI