CCTA May Replace Invasive Angiography in Coronary Disease Diagnosis
CCTA May Replace Invasive Angiography in Coronary Disease Diagnosis
Updated July 2025 – Based on a clinical update (July 28, 2025) and peer-reviewed data from EuroIntervention (2025).
1. Shift in Diagnostic Strategy
• For decades, invasive coronary angiography (ICA) has been the standard for diagnosing coronary artery disease (CAD).
• Today, experts predict that coronary computed tomography angiography (CCTA) may soon eliminate the need for diagnostic catheterization.
2. What Has Changed?
• Hardware, software, and AI advancements in CT imaging have made CCTA highly accurate.
• FFR-CT (Fractional Flow Reserve derived from CT) and soft plaque analysis now allow noninvasive imaging to match or surpass ICA in diagnostic value.
3. Expert Perspective
• Dr. John D. Puskas (Emory University Hospital Midtown) states:
“We still rely on ICA, but like outdated cameras, it’s becoming obsolete. CCTA is rapidly taking its place.”
4. Clinical Impact and Adoption
• Initially used for structural heart assessments (e.g., TAVR planning), CCTA is now rapidly being adopted for:
• Coronary plaque assessment
• Surgical planning (CABG)
• PCI decisions
5. Future Role of ICA
• ICA may soon be reserved only for interventional purposes (PCI), not diagnostics.
• Screening and treatment planning will likely rely on CCTA + AI.
6. Heart Team and AI Integration
• The heart team model (surgeons + interventionalists + imagers) is key to collaborative decisions in cardiac care.
• AI and CCTA can:
• Standardize decision-making.
• Resolve biases in centers where competition between specialties affects care.
• Guide decisions between CABG vs PCI based on objective, patient-specific data.
7. Toward Personalized, Noninvasive Care
• Dr. Puskas envisions a future where AI-assisted CCTA becomes mandatory in evaluating CAD.
