[Which role for coronary CT angiography in cardiovascular prevention?]

Coronary CT angiography (CCTA) is a reference technique for the non-invasive visualization of coronary atherosclerosis. In primary prevention, its aim is not population screening but targeted use to refine risk stratification in selected individuals. Cohort data show that subclinical atherosclerosis is frequent, including in low-risk subjects. While coronary artery calcium (CAC) scoring is an established tool for risk reclassification, CCTA enables a more detailed assessment, particularly of non-calcified plaque and high-risk components. In the absence of randomized trial evidence demonstrating clear clinical benefits, its use remains limited to selected indications. Advances in automated analysis and plaque quantification nevertheless open research perspectives.