Long-Term Prognostic Value of Coronary Computed Tomography Angiography

Area of Science:

• Cardiovascular Imaging
• Diagnostic Cardiology
• Preventive Cardiology

Background:

• Coronary CT angiography (CTA) is a leading non-invasive test for diagnosing coronary artery disease (CAD).
• CTA uniquely visualizes coronary atherosclerosis, assessing stenosis and plaque vulnerability.
• Current guidelines and criteria direct the appropriate use of CTA in clinical practice.

Purpose of the Study:

• To review the long-term prognostic value of coronary CTA (≥5 years follow-up).
• To highlight how CTA findings predict future cardiovascular events.
• To discuss the role of CTA in guiding preventive therapies.

Main Methods:

• Systematic review of recent literature on long-term prognostic outcomes of coronary CTA.
• Analysis of studies reporting cardiovascular events, mortality, and revascularizations.
• Evaluation of the impact of CTA findings on treatment decisions.

Main Results:

• Absence of CAD on CTA indicates a very low risk of future cardiovascular events.
• CTA-derived information on CAD presence, location, and severity offers superior prognostic power compared to traditional risk factors.
• CTA use is associated with increased utilization of statins and aspirin, leading to reduced mortality, revascularizations, and myocardial infarctions.

Conclusions:

• Coronary CTA provides robust long-term prognostic information for patients with or without CAD.
• Standardized reporting of CTA, including vulnerable plaque features, enhances the link between imaging findings and preventive interventions.
• Emerging technologies like AI and CT-derived FFR may further improve CTA's prognostic accuracy.