To learn how to assess coronary CT angiography (CTA) relevant to percutaneous coronary intervention (PCI).

To learn how coronary CTA can help to select patients for revascularisation, plan PCI and guide procedures in the catheterisation laboratory.

To realise the benefit of CT-guided PCI.

Coronary CT angiography (CTA) is recommended as the first-line diagnostic evaluation for patients presenting with chest pain.1 As a result, a significant proportion of patients referred to the catheterisation laboratory now undergo coronary CTA assessment before the invasive procedure. This approach has been shown to reduce the frequency of major procedure-related complications.2 Nonetheless, coronary CTA is primarily used as a trigger for deciding to perform an invasive angiogram. Despite the undeniable value of coronary CTA in providing anatomical information, its role in guiding revascularisation procedures is often underutilised.

The systematic utilisation of coronary CTA in the field of interventional cardiology is hindered by the limited familiarity of interventional cardiologists with CT imaging. However, for readers who are well-versed in invasive angiography and intravascular imaging, grasping the fundamentals of coronary CTA is relatively straightforward. To enhance comprehension, figure 1 provides a comprehensive overview of the essential CT reconstructions pertinent to the revascularisation procedure and the approaches for plaque characterisation. This visual resource facilitates a better understanding of the concepts discussed in this manuscript.

Detailed coronary assessment in different CT-reconstruction modalities. Panel (A) shows three CT-reconstruction modalities (volume rendering, three-dimensional multi-intensity projection (3D-MIP), curved MPR) and axial image, together with the corresponding anatomical information data that can be extracted from them. Panel (B) shows three typical patterns of plaque (lipidic, fibrotic, calcified) that can be observed in the vessel cross-section modality. MPR, multi-planner reconstruction.

In this review, we aim to shed light on the critical assessment of anatomical and functional information derived from coronary CTA that is …