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Medicina
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Coronary CT Angiography in Coronary Artery Disease: Challenges and Future...
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Coronary CT Angiography in Coronary Artery Disease: Challenges and Future Opportunities

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 January 2026) | Viewed by 2990

Special Issue Editors

Dr. Nikolaos Ktenopoulos

E-Mail Website
Guest Editor
First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
Interests: interventional cardiology; coronary artery disease; CT angiography
Dr. Andreas Synetos

E-Mail Website
Guest Editor
1. First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
2. Medical School, European University of Cyprus, Egkom 2404, Cyprus
Interests: interventional cardiology; structural heart disease; TAVI; chronic total occlusions. rxperimental models of aortic valve stenosis. exoerimental cardiology

Special Issue Information

Dear Colleagues,

Coronary computed tomography angiography (CCTA) has emerged as a transformative non-invasive imaging modality in the diagnosis, risk stratification, and management of coronary artery disease (CAD). With continual advances in scanner technology—including dual-source, spectral imaging, and, more recently, photon-counting CT—CCTA now offers unprecedented resolution and diagnostic precision. The evolving integration of artificial intelligence, plaque characterization, and CT-derived fractional flow reserve (FFR-CT) further positions CCTA as a cornerstone of personalized cardiovascular care.

This Special Issue aims to explore the current applications and future opportunities of CCTA across the full spectrum of CAD, from stable angina and INOCA/ANOCA to acute coronary syndromes and complex revascularization planning. We invite original research articles, reviews, and insights that address the clinical utility, technical challenges, comparative effectiveness, and innovative roles of CCTA in diverse populations and clinical scenarios.

By bringing together contributions from experienced clinicians and researchers, this Special Issue seeks to foster multidisciplinary dialogue and advance the implementation of CCTA in routine and precision cardiology.

Dr. Nikolaos Ktenopoulos
Dr. Andreas Synetos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary CT angiography
  • coronary artery disease
  • cardiac imaging
  • non-invasive imaging
  • INOCA/ANOCA

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Published Papers (3 papers)

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Research

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19 pages, 935 KB  
Article
Computed Tomography in the Evaluation and Identification of Features of Coronary Atherosclerosis Between European and Asian Populations in Kazakhstan
by Tairkhan Dautov, Elmira Yelshibayeva, Makhabbat Tynybekova, Bakyt Duisenbayeva, Lazzat Bastarbekova, Tokhirzhon Tashpulatov, Kuralay Sharipova, Shokhrukh Akhnazarov, Daniyar Kudabayev, Kemelya Nigmetova and Nurly Kapashova
Medicina 2026, 62(3), 527; https://doi.org/10.3390/medicina62030527 - 12 Mar 2026
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Abstract
Background and Objectives: This study aimed to compare coronary plaque characteristics between Asian and European populations undergoing coronary CT angiography and to examine associations between cardiovascular risk factors and coronary artery calcification. Materials and Methods: In this retrospective, two-center, cross-sectional observational [...] Read more.
Background and Objectives: This study aimed to compare coronary plaque characteristics between Asian and European populations undergoing coronary CT angiography and to examine associations between cardiovascular risk factors and coronary artery calcification. Materials and Methods: In this retrospective, two-center, cross-sectional observational study, 1591 adult patients (1203 of Asian and 388 of European descent) referred for coronary computed tomography angiography (CCTA) due to suspected coronary artery disease between 2008 and 2025 were included. Demographic, clinical characteristics, and laboratory data were obtained from medical records. Computed tomography (CT) was performed on different CT scanners, including a 64-slice Siemens SOMATOM Definition AS, a 250-slice Siemens SOMATOM, a 640-slice multi-detector Canon Aquilion ONE, and a 128-slice multi-detector GE Revolution scanner with prospective cardiac synchronization and 0.6 mm slice reconstruction. Coronary artery calcium (CAC) scores were quantified using automated software “Vitrea”. Associations between ethnicity, cardiovascular risk factors, and CAC were assessed using non-parametric analyses and multivariable regression models. Stata 18 software was used for all statistical analyses. Results: European participants demonstrated a higher prevalence of obesity, hypertension, tobacco use, and alcohol consumption compared with Asian participants. The prevalence of CAC > 0 was higher in Europeans than in Asians (60.6% vs. 50.3%, p < 0.01). European individuals were independently associated with CAC presence in multivariable analysis. Multivessel (≥2-vessel) stenosis and calcified plaques were more frequently observed in Europeans, whereas non-calcified and low-density plaques predominated among Asians. Conclusions: Within this referral-based cohort, differences in coronary plaque characteristics were observed between the studied groups within this clinical CCTA cohort. The European group was associated with a higher prevalence of calcified plaques, whereas non-calcified and low-density plaques were more frequently observed among Asian participants. These findings show associations between ethnicity and plaque characteristics within a clinical cohort and require confirmation in prospective studies. Full article
(This article belongs to the Special Issue Coronary CT Angiography in Coronary Artery Disease: Challenges and Future Opportunities)
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Review

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17 pages, 2298 KB  
Review
Computed Tomography Coronary Angiography as a Gatekeeper for Invasive Coronary Assessment Before Transcatheter Aortic Valve Implantation
by Anastasios Apostolos, Nikolaos Ktenopoulos, Theoni Theodoropoulou, Panayotis Vlachakis, Paschalis Karakasis, Nikias Milaras, Panagiotis Iliakis, Andreas Synetos, George Latsios, Maria Drakopoulou, Grigorios Chrysostomidis, Grigorios Tsigkas, Konstantinos Toutouzas, Konstantinos Tsioufis and Vasileios Panoulas
Medicina 2026, 62(4), 673; https://doi.org/10.3390/medicina62040673 - 1 Apr 2026
Cited by 1 | Viewed by 580
Abstract
Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography [...] Read more.
Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography coronary angiography (CTCA), which is already integral to TAVI planning for annular sizing and access route evaluation, offers the potential to assess coronary anatomy simultaneously. Accumulating evidence demonstrates that CTCA possesses excellent sensitivity (90–97%) and high negative predictive value (94–99%) for excluding significant proximal CAD, potentially serving as a reliable gatekeeper to avoid unnecessary ICA in a substantial proportion of patients. This approach is particularly attractive given the questionable benefit of routine pre-emptive coronary revascularization in stable TAVI candidates, as demonstrated by the ACTIVATION and NOTION-3 trials. This review synthesizes the current evidence on the diagnostic performance of CTCA, clinical outcomes with CT-guided strategies, technical considerations and limitations, and the evolving paradigm of coronary assessment in the contemporary TAVI era. We propose a practical algorithm integrating CTCA as a first-line screening tool, reserving ICA for patients with suspected significant proximal disease, thereby optimizing resource utilization while maintaining patient safety. Full article
(This article belongs to the Special Issue Coronary CT Angiography in Coronary Artery Disease: Challenges and Future Opportunities)
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23 pages, 1104 KB  
Review
Coronary CT Angiography for PCI Planning and Guidance: A Comprehensive Narrative Review
by Lorenzo Fargione, Pietro Laforgia, Thomas Hovasse, Bernard Chevalier, Nicolas Amabile, Francesca Sanguineti, Stephane Champagne, Thierry Unterseeh, Antoinette Neylon, Neila Sayah, Jerome Garot, Lisa Simioni, Mario Togni, Stephane Cook, Hakim Benamer, Livio D’Angelo, Philippe Garot, Mariama Akodad and Ioannis Skalidis
Medicina 2026, 62(2), 313; https://doi.org/10.3390/medicina62020313 - 3 Feb 2026
Cited by 1 | Viewed by 1382
Abstract
Coronary computed tomography angiography (CCTA) is increasingly recognized as a comprehensive tool for planning percutaneous coronary intervention (PCI). By integrating plaque morphology, calcium burden, and CT-derived coronary physiology, CCTA enables non-invasive assessment of lesion complexity and supports precision-guided revascularization. This narrative review synthesizes [...] Read more.
Coronary computed tomography angiography (CCTA) is increasingly recognized as a comprehensive tool for planning percutaneous coronary intervention (PCI). By integrating plaque morphology, calcium burden, and CT-derived coronary physiology, CCTA enables non-invasive assessment of lesion complexity and supports precision-guided revascularization. This narrative review synthesizes current evidence on CT-guided PCI from original studies, registries, expert consensus documents, and international guideline recommendations. The literature was identified through PubMed, Embase, and Google Scholar, focusing on CCTA-based plaque characterization, calcium assessment, bifurcation and ostial lesions, chronic total occlusions (CTO), FFR-CT, virtual PCI simulation, and fusion imaging. Particular attention was given to contemporary investigations such as SYNTAX III, P3, and the ongoing P4 trial. CCTA reliably characterizes stenosis severity, plaque distribution, and calcification, demonstrating strong concordance with intravascular imaging. CT-based measurements support accurate stent sizing, prediction of calcium modification requirements, and identification of high-risk features in bifurcation and ostial disease. In CTO PCI, CCTA enhances visualization of proximal cap morphology, occlusion length, tortuosity, and distal vessel quality, outperforming angiographic scoring systems. CT-derived physiology and virtual PCI planning improve lesion selection and allow prediction of post-PCI hemodynamics. Emerging technologies—including photon-counting CT, artificial intelligence-assisted plaque analysis, and CT–fluoroscopy fusion—further expand the applicability of CT-guided PCI. The ongoing P4 trial is expected to provide definitive validation of CT-guided PCI and may support its incorporation into routine clinical workflows. Full article
(This article belongs to the Special Issue Coronary CT Angiography in Coronary Artery Disease: Challenges and Future Opportunities)
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