Update on the clinical utility of coronary computed tomographic angiography in stable angina pectoris

Over the last decade, coronary computed tomographic angiography (CCTA) has emerged as a valuable non-invasive imaging modality with excellent diagnostic performance compared to invasive coronary angiography (ICA) for identifying patients with coronary artery disease (CAD). Beyond the diagnosis of CAD, CCTA also provides valuable prognostic information. While patients with normal CCTA have excellent long-term prognosis, among those with CAD, increasing CAD extent and severity is associated with increased cardiovascular event risk over both medium- and long-term follow-up in both men and women. The ability to image non-obstructive CAD is a particularly unique attribute of CCTA. Moreover, the ability to assess plaque features on CCTA has further enhanced our understanding of coronary plaque dynamics and the prediction of future cardiovascular events. The clinical impact of CCTA has been recently evaluated in two landmark prospective multicenter trials, which have provided insights into the influence of CCTA on the clinical management of symptomatic patients with suspected CAD. We review the value of CCTA in the evaluation of patients with stable chest pain including its diagnostic performance, prognostic utility and real-world clinical application.