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Page e13 Coronary CT Angiography (CCTA) has been widely used as a reliable non-invasive modality for the diagnosis of Coronary Artery Disease (CAD) due to its improved spatial and temporal resolution.1-5 For patients with low to intermediate pre-test probability of CAD, CCTA is used as an effective gatekeeper for determination of downstream testing, such as invasive coronary angiography or functional imaging.6 However, CCTA is mainly an anatomic test with excellent visualization of coronary anatomical structures and detection of coronary lumen stenosis, while providing little functional information of the coronary lesions. Despite high sensitivity and negative predictive value, CCTA has been reported to have moderate specificity and positive predictive value due to the high percentage of false positive rates, and this is especially apparent in the assessment of coronary arteries with heavy calcification. Studies have shown the limited diagnostic value of CCTA in diagnosing highly calcified coronary plaques.7-11 Thus, an imaging technique able to detect ischemia-producing lesions is of paramount importance since coronary stenosis does not always translate to functional significance. Clinical decision making of whether patients should proceed to a revascularization procedure is based on the predictive functional effect of coronary stenosis, because no prognostic benefit of revascularization has been reported in the coronary lesions without functional significance.12,13

The PLATFORM Trial: An Insight into the Improved Value of Using FFRCT for Reduction of Invasive Angiographic Procedures