Computed Tomography Coronary Angiogram; updates Regarding Evidence, Clinical Applications, and Emerging Technologies: A Literature of Review

Assessing of the coronary artery disease (CAD) especially coronary stenosis by coronary computed tomography angiography (CCTA) has shown a classic shift in the last decades. Recent advancements in cardiac CT have improved the quality of image and decreased exposure of patients to radiation. CCTA is a noninvasive technique for visualizing the anatomy of CAD. CCTA, in combination with newer techniques like plaque characterization, physiologic and functional evaluation, leads to accurate diagnostic and prognostic evaluation of any low to intermediate subjects for prevention. Evidence strongly recommends the use of CCTA all over the stages of CAD, early from detecting of minute subclinical diseases up to the estimation of acute chest pain. Furthermore, CCTA can be used to noninvasively quantify plaque burden and identify high-risk plaque, which can help with diagnosis, prognosis, and treatment. This is especially important in the evaluation of CAD in immune-driven conditions with a higher prevalence of cardiovascular disease. Furthermore, key findings from large cohort trials have contributed to a better understanding of cardiovascular disease risk as a function of overall coronary plaque burden and the morphological appearance of individual plaques. With the introduction of CT-derived fractional flow reserve, an anatomical and functional test will be established within a single modality. Recent research has been published that looks at the short-term impact of CT-derived fractional flow reserve on downstream care and clinical outcomes. Furthermore, machine learning is a concept that is increasingly being applied to diagnostic medicine. Emerging CCTA applications based on hemodynamic indices and plaque characterization may provide personalized risk assessment, influence disease detection, and guide therapy further. This review provides an update on the evidence, clinical applications, and emerging technologies related to CCTA. We also discuss how CCTA could be used to characterize coronary atherosclerosis, stratify asymptomatic subjects' prognosis, and guide medical therapy.