Abstract

Coronary computed tomographic angiography (CCTA) has undergone groundbreaking developments over the past two decades and is now among the first-line investigations in the diagnosis of stable chest pain, as recommended by several national and international guidelines. CCTA allows to exclude haemodynamically significant stenoses with a high degree of accuracy and is slowly becoming a gatekeeper test prior to invasive angiography, aiding in the selection of patients requiring revascularisation. The advent of new technologies such as computed flow reserve and CT perfusion in recent years has also made it possible to assess the haemodynamic consequences of stenoses. CCTA also complements the calcium score, which has been used for many years. It allows, in addition to calcification imaging, to assess the structure of atherosclerosis, detecting high-risk plaques and predicting the risk of rupture. To sum up, it can be concluded that non-invasive coronary imaging is now firmly established in the diagnostic workup of coronary artery disease.