Cardiac CT: the end of invasive coronary angiography as a diagnostic procedure?

In recent years, multislice computed tomographic (CT) technology has progressed rapidly, with significant improvements in spatial and temporal resolution, and has become a powerful technique for coronary artery evaluation. Although invasive angiography is still considered the gold standard for the diagnosis of coronary artery disease, there are several indications for which coronary CT angiography (CTA) may become the first-line exam, instead of invasive catheter-based coronary angiography. Because of its high negative predictive value, CTA is very useful to rule out significant coronary stenosis, thus avoiding unnecessary invasive diagnostic procedures, particularly in patients with intermediate probability and inconclusive stress tests and/or symptoms, or in routine coronary evaluation of patients scheduled for valvular or aortic surgery. CTA is not limited to non-invasive coronary angiography; it can make important additional diagnostic contributions in both extra-coronary cardiac evaluation, such as left ventricular function, and assessment of extracardiac findings.