SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography

Published:November 19, 2020DOI:https://doi.org/10.1016/j.jcct.2020.11.001
      Cardiac computed tomography (CT) has changed rapidly since the last major guideline from SCCT.
      • Abbara S.
      • Arbab-Zadeh A.
      • Callister T.Q.
      • et al.
      SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.
      While there have been significant advances in technology, the most gratifying part has been the development of a robust evidence base for the use of cardiac CT in diagnoses of heart disease, prognostication and modulating therapy (both medical and interventional). Such a systematic development of knowledge base has not been the usual practice for any other imaging modality before widespread clinical acceptance in the past. It is no surprise that major guideline bodies have started to endorse incorporation of cardiac CT more definitively than before, and some, like the NICE guidelines in the UK,
      • NICE
      Putting NICE Guidance into Practice. Resource Impact Report: Chest Pain of Recent Onset: Assessment and Diagnosis.
      have even given it first line status. While CTA has been shown to be very good for prognosticating risk, excluding significant coronary artery disease (CAD) in stable patients with chest pain and has high sensitivity for the identification of significant coronary stenoses, it is somewhat less robust in specificity and positive predictive accuracy, leading to the development of value added CT angiography (CTA) strategies like fractional flow reserve derived from CT (CT-FFR) and CT perfusion (CTP); these have arrived into the clinical arena since the last guidelines and, more importantly, have produced a large volume of scientific data showing significant clinical utility. Finally, some questions that often arise in regular clinical practice lack robust trial based evidence and a considered expert opinion might help the clinician make appropriate decisions in everyday practice. It is thus clear that an updated scholarly compendium of recent data is needed to bridge the knowledge gap since the last iteration of the SCCT guideline documents. This SCCT consensus statement summarizes current evidence, updates previous recommendations, addresses key questions regarding the use of CTA in multiple different cardiac scenarios and brings together the collective corpus of literature in the form of definitive recommendations. CTA in acute coronary syndromes will be presented in a separate document. The Expert Consensus recommendations are summarized in Table 1 and Fig. 1.
      Fig. 1
      Fig. 1Central Illustration Role of CTA in chronic CAD. Also please see .
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      References

        • Abbara S.
        • Arbab-Zadeh A.
        • Callister T.Q.
        • et al.
        SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.
        J Cardiovasc Comput Tomogr. 2009; 3: 190-204
        • NICE
        Putting NICE Guidance into Practice. Resource Impact Report: Chest Pain of Recent Onset: Assessment and Diagnosis.
        2016
        • Danad I.
        • Szymonifka J.
        • Twisk J.W.R.
        • et al.
        Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis.
        Eur Heart J. 2017; 38: 991-998
        • Tonino P.A.
        • De Bruyne B.
        • Pijls N.H.
        • et al.
        Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
        N Engl J Med. 2009; 360: 213-224
        • van Nunen L.X.
        • Zimmermann F.M.
        • Tonino P.A.
        • et al.
        Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial.
        Lancet. 2015; 386: 1853-1860
        • Zimmermann F.M.
        • Ferrara A.
        • Johnson N.P.
        • et al.
        Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial.
        Eur Heart J. 2015; 36: 3182-3188
        • Harle T.
        • Zeymer U.
        • Hochadel M.
        • et al.
        Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry.
        Clin Res Cardiol. 2017; 106: 140-150
        • Desai N.R.
        • Bradley S.M.
        • Parzynski C.S.
        • et al.
        Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention.
        J Am Med Assoc. 2015; 314: 2045-2053
        • Patel M.R.
        • Dai D.
        • Hernandez A.F.
        • et al.
        Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice.
        Am Heart J. 2014; 167: 846-852 e2
        • Fleischmann K.E.
        • Hunink M.G.
        • Kuntz K.M.
        • Douglas P.S.
        Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance.
        J Am Med Assoc. 1998; 280: 913-920
        • de Jong M.C.
        • Genders T.S.
        • van Geuns R.J.
        • Moelker A.
        • Hunink M.G.
        Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis.
        Eur Radiol. 2012; 22: 1881-1895
        • Jaarsma C.
        • Leiner T.
        • Bekkers S.C.
        • et al.
        Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis.
        J Am Coll Cardiol. 2012; 59: 1719-1728
        • Nielsen L.H.
        • Ortner N.
        • Norgaard B.L.
        • Achenbach S.
        • Leipsic J.
        • Abdulla J.
        The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis.
        Eur Heart J Cardiovasc Imaging. 2014; 15: 961-971
        • Arbab-Zadeh A.
        • Di Carli M.F.
        • Cerci R.
        • et al.
        Accuracy of computed tomographic angiography and single-photon emission computed tomography-acquired myocardial perfusion imaging for the diagnosis of coronary artery disease.
        Circ Cardiovasc Imaging. 2015; 8e003533
        • Takx R.A.
        • Blomberg B.A.
        • El Aidi H.
        • et al.
        Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis.
        Circ Cardiovasc Imaging. 2015; 8
        • Dai N.
        • Zhang X.
        • Zhang Y.
        • et al.
        Enhanced diagnostic utility achieved by myocardial blood analysis: a meta-analysis of noninvasive cardiac imaging in the detection of functional coronary artery disease.
        Int J Cardiol. 2016; 221: 665-673
        • Danad I.
        • Raijmakers P.G.
        • Driessen R.S.
        • et al.
        Comparison of Coronary CT Angiography, SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve..
        JAMA Cardiol. 2017; 2: 1100-1107
        • Hoffmann U.
        • Ferencik M.
        • Udelson J.E.
        • et al.
        Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: insights from the PROMISE trial (prospective multicenter imaging study for evaluation of chest pain).
        Circulation. 2017; 135: 2320-2332
        • Xie J.X.
        • Cury R.C.
        • Leipsic J.
        • et al.
        The coronary artery disease-reporting and data system (CAD-RADS): prognostic and clinical implications associated with standardized coronary computed tomography angiography reporting.
        JACC Cardiovasc Imaging. 2018; 11: 78-89
        • Rubinshtein R.
        • Hamdan A.
        Coronary CTA-based CAD-RADS reporting system and the PROMISE to predict cardiac events.
        JACC Cardiovasc Imaging. 2019; 13: 1546-1548
        • Andreini D.
        • Pontone G.
        • Mushtaq S.
        • et al.
        Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: results from the COronary CT angiography EvaluatioN for clinical outcomes InteRnational multicenter (CONFIRM) study.
        Int J Cardiol. 2017; 231: 18-25
        • Bittencourt M.S.
        • Hulten E.
        • Ghoshhajra B.
        • et al.
        Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events.
        Circ Cardiovasc Imaging. 2014; 7: 282-291
        • Hell M.M.
        • Motwani M.
        • Otaki Y.
        • et al.
        Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up.
        European heart journal cardiovascular Imaging. 2017; 18: 1331-1339
        • Chang H.J.
        • Lin F.Y.
        • Lee S.E.
        • et al.
        Coronary atherosclerotic precursors of acute coronary syndromes.
        J Am Coll Cardiol. 2018; 71: 2511-2522
        • Lee S.-E.
        • Sung J.M.
        • Andreini D.
        • et al.
        Differences in progression to obstructive lesions per high-risk plaque features and plaque volumes with CCTA.
        JACC Cardiovascular imaging. 2019; S1936–878X: 30934-30939
        • Halon D.A.
        • Lavi I.
        • Barnett-Griness O.
        • et al.
        Plaque morphology as predictor of late plaque events in patients with asymptomatic type 2 diabetes: a long-term observational study.
        JACC Cardiovasc Imaging. 2019 Jul; 12: 1353-1363
        • van Rosendael A.R.
        • Shaw L.J.
        • Xie J.X.
        • et al.
        Superior risk stratification with coronary computed tomography angiography using a comprehensive atherosclerotic risk score.
        JACC Cardiovasc Imaging. 2019; 12: 1987-1997
        • Motoyama S.
        • Kondo T.
        • Sarai M.
        • et al.
        Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes.
        J Am Coll Cardiol. 2007; 50: 319-326
        • Maurovich-Horvat P.
        • Schlett C.L.
        • Alkadhi H.
        • et al.
        The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography.
        JACC Cardiovasc Imaging. 2012; 5: 1243-1252
        • Motoyama S.
        • Ito H.
        • Sarai M.
        • et al.
        Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up.
        J Am Coll Cardiol. 2015; 66: 337-346
        • Ferencik M.
        • Mayrhofer T.
        • Bittner D.O.
        • et al.
        Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial.
        JAMA Cardiol. 2018; 3: 144-152
        • Williams M.C.
        • Moss A.J.
        • Dweck M.
        • et al.
        Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-heart study.
        J Am Coll Cardiol. 2019; 73: 291-301
        • Investigators S.-H.
        CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.
        Lancet. 2015; 385: 2383-2391
        • Driessen R.S.
        • de Waard G.A.
        • Stuijfzand W.J.
        • et al.
        Adverse plaque characteristics relate more strongly with hyperemic fractional flow reserve and instantaneous wave-free ratio than with resting instantaneous wave-free ratio.
        JACC Cardiovasc Imaging. 2020; 13: 746-756
        • Gonzalez J.A.
        • Lipinski M.J.
        • Flors L.
        • Shaw P.W.
        • Kramer C.M.
        • Salerno M.
        Meta-analysis of diagnostic performance of coronary computed tomography angiography, computed tomography perfusion, and computed tomography-fractional flow reserve in functional myocardial ischemia assessment versus invasive fractional flow reserve.
        Am J Cardiol. 2015; 116: 1469-1478
        • Celeng C.
        • Leiner T.
        • Maurovich-Horvat P.
        • et al.
        Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis.
        JACC Cardiovasc Imaging. 2019 Jul; 12: 1316-1325
        • Adamson P.D.
        • Newby D.E.
        • Hill C.L.
        • Coles A.
        • Douglas P.S.
        • Fordyce C.B.
        Comparison of international guidelines for assessment of suspected stable Angina: insights from the PROMISE and SCOT-heart.
        JACC Cardiovasc Imaging. 2018; 11: 1301-1310
        • Baskaran L.
        • Danad I.
        • Gransar H.
        • et al.
        A comparison of the updated diamond-forrester, CAD consortium, and CONFIRM history-based risk scores for predicting obstructive coronary artery disease in patients with stable chest pain: the SCOT-heart coronary CTA cohort.
        JACC Cardiovasc Imaging. 2019; 12: 1392-1400
        • Genders T.S.S.
        • Coles A.
        • Hoffmann U.
        • et al.
        The external validity of prediction models for the diagnosis of obstructive coronary artery disease in patients with stable chest pain: insights from the PROMISE trial.
        JACC Cardiovasc Imaging. 2018; 11: 437-446
        • Andreini D.
        • Pontone G.
        • Mushtaq S.
        • et al.
        A long-term prognostic value of coronary CT angiography in suspected coronary artery disease.
        JACC Cardiovasc Imaging. 2012; 5: 690-701
        • Min J.K.
        • Shaw L.J.
        • Devereux R.B.
        • et al.
        Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality.
        J Am Coll Cardiol. 2007; 50: 1161-1170
        • Hadamitzky M.
        • Taubert S.
        • Deseive S.
        • et al.
        Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease.
        Eur Heart J. 2013; 34: 3277-3285
        • Kang S.H.
        • Park G.M.
        • Lee S.W.
        • et al.
        Long-term prognostic value of coronary CT angiography in asymptomatic type 2 diabetes mellitus.
        JACC Cardiovasc Imaging. 2016; 9: 1292-1300
        • Clerc O.F.
        • Kaufmann B.P.
        • Possner M.
        • et al.
        Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering.
        Eur Radiol. 2017; 27: 4650-4660
        • Shaw L.J.
        • Hage F.G.
        • Berman D.S.
        • Hachamovitch R.
        • Iskandrian A.
        Prognosis in the era of comparative effectiveness research: where is nuclear cardiology now and where should it be?.
        J Nucl Cardiol. 2012; 19: 1026-1043
        • Smulders M.W.
        • Jaarsma C.
        • Nelemans P.J.
        • et al.
        Comparison of the prognostic value of negative non-invasive cardiac investigations in patients with suspected or known coronary artery disease-a meta-analysis.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 980-987
        • Finck T.
        • Hardenberg J.
        • Will A.
        • et al.
        10-Year follow-up after coronary computed tomography angiography in patients with suspected coronary artery disease.
        JACC Cardiovasc Imaging. 2019; 12: 1330-1338
        • Min J.K.
        • Dunning A.
        • Lin F.Y.
        • et al.
        Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter Registry) of 23,854 patients without known coronary artery disease.
        J Am Coll Cardiol. 2011; 58: 849-860
        • Hadamitzky M.
        • Achenbach S.
        • Al-Mallah M.
        • et al.
        Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN for Clinical Outcomes: an InteRnational Multicenter Registry).
        J Am Coll Cardiol. 2013; 62: 468-476
        • Nielsen L.H.
        • Botker H.E.
        • Sorensen H.T.
        • et al.
        Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study.
        Eur Heart J. 2017; 38: 413-421
        • Ostrom M.P.
        • Gopal A.
        • Ahmadi N.
        • et al.
        Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography.
        J Am Coll Cardiol. 2008; 52: 1335-1343
        • Cantoni V.
        • Green R.
        • Acampa W.
        • et al.
        Long-term prognostic value of stress myocardial perfusion imaging and coronary computed tomography angiography: a meta-analysis.
        J Nucl Cardiol. 2016; 23: 185-197
        • Hadamitzky M.
        • Freissmuth B.
        • Meyer T.
        • et al.
        Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease.
        JACC Cardiovasc Imaging. 2009; 2: 404-411
        • Chow B.J.
        • Small G.
        • Yam Y.
        • et al.
        Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: COroNary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry.
        Circ Cardiovasc Imaging. 2011; 4: 463-472
        • Min J.K.
        • Labounty T.M.
        • Gomez M.J.
        • et al.
        Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals.
        Atherosclerosis. 2014; 232: 298-304
        • Villines T.C.
        • Hulten E.A.
        • Shaw L.J.
        • et al.
        Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry.
        J Am Coll Cardiol. 2011; 58: 2533-2540
        • Douglas P.S.
        • Hoffmann U.
        • Patel M.R.
        • et al.
        Outcomes of anatomical versus functional testing for coronary artery disease.
        N Engl J Med. 2015; 372: 1291-1300
        • Investigators S.-H.
        • Newby D.E.
        • Adamson P.D.
        • et al.
        Coronary CT angiography and 5-year risk of myocardial infarction.
        N Engl J Med. 2018; 379: 924-933
        • McKavanagh P.
        • Lusk L.
        • Ball P.A.
        • et al.
        A comparison of cardiac computerized tomography and exercise stress electrocardiogram test for the investigation of stable chest pain: the clinical results of the CAPP randomized prospective trial.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 441-448
        • Lubbers M.
        • Dedic A.
        • Coenen A.
        • et al.
        Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial.
        Eur Heart J. 2016; 37: 1232-1243
        • Min J.K.
        • Koduru S.
        • Dunning A.M.
        • et al.
        Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial.
        J Cardiovasc Comput Tomogr. 2012; 6: 274-283
        • Lubbers M.
        • Coenen A.
        • Kofflard M.
        • et al.
        Comprehensive cardiac CT with myocardial perfusion imaging versus functional testing in suspected coronary artery disease: the multicenter, randomized CRESCENT-II trial.
        JACC Cardiovascular imaging. 2018; 11: 1625-1636
        • Newby D.E.
        • Williams M.C.
        • Flapan A.D.
        • et al.
        Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, the Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial.
        Trials. 2012; 13: 184
        • Williams M.C.
        • Hunter A.
        • Shah A.
        • et al.
        Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial.
        Heart. 2017; 103: 995-1001
        • Douglas P.S.
        • Hoffmann U.
        Anatomical versus functional testing for coronary artery disease.
        N Engl J Med. 2015; 373: 91
        • Bittencourt M.S.
        • Hulten E.A.
        • Murthy V.L.
        • et al.
        Clinical outcomes after evaluation of stable chest pain by coronary computed tomographic angiography versus usual care: a meta-analysis.
        Circ Cardiovasc Imaging. 2016; 9e004419
        • Jorgensen M.E.
        • Andersson C.
        • Norgaard B.L.
        • et al.
        Functional testing or coronary computed tomography angiography in patients with stable coronary artery disease.
        J Am Coll Cardiol. 2017; 69: 1761-1770
        • Adamson P.D.
        • Williams M.C.
        • Dweck M.R.
        • et al.
        Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain.
        J Am Coll Cardiol. 2019; 74: 2058-2070
        • Xie J.X.
        • Shaw L.J.
        Measuring diagnostic health care costs in stable coronary artery disease: should we follow the money?.
        Ann Intern Med. 2016; 165: 147-148
        • Shaw L.J.
        • Phillips L.M.
        • Nagel E.
        • Newby D.E.
        • Narula J.
        • Douglas P.S.
        Comparative effectiveness trials of imaging-guided strategies in stable ischemic heart disease.
        JACC Cardiovasc Imaging. 2017; 10: 321-334
        • Shaw L.J.
        • Hausleiter J.
        • Achenbach S.
        • et al.
        Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures: results from the multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry.
        J Am Coll Cardiol. 2012; 60: 2103-2114
        • Mark D.B.
        • Federspiel J.J.
        • Cowper P.A.
        • et al.
        Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease.
        Ann Intern Med. 2016; 165: 891
        • Hlatky M.A.
        • De Bruyne B.
        • Pontone G.
        • et al.
        Quality-of-Life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM.
        J Am Coll Cardiol. 2015; 66: 2315-2323
        • Shaw L.J.
        • Mieres J.H.
        • Hendel R.H.
        • et al.
        Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the what Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial.
        Circulation. 2011; 124: 1239-1249
        • Thom H.
        • West N.E.
        • Hughes V.
        • et al.
        Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial.
        BMJ open. 2014; 4e003419
        • Williams M.C.
        • Hunter A.
        • Shah A.S.
        • et al.
        Use of coronary computed tomographic angiography to guide management of patients with coronary disease.
        J Am Coll Cardiol. 2016; 67: 1759-1768
        • Walker S.
        • Girardin F.
        • McKenna C.
        • et al.
        Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study.
        Heart. 2013; 99: 873-881
        • Timmis A.
        Investigation of patients presenting with chest pain.
        Heart. 2015; 101: 1252
        • Moss A.J.
        • Williams M.C.
        • Newby D.E.
        • Nicol E.D.
        The updated NICE guidelines: cardiac CT as the first-line test for coronary artery disease.
        Curr Cardiovasc Imaging Rep. 2017; 10: 15
        • Patel M.R.
        • Peterson E.D.
        • Dai D.
        • et al.
        Low diagnostic yield of elective coronary angiography.
        N Engl J Med. 2010; 362: 886-895
        • Motoyama S.
        • Sarai M.
        • Harigaya H.
        • et al.
        Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome.
        J Am Coll Cardiol. 2009; 54: 49-57
        • Lee J.M.
        • Choi G.
        • Koo B.K.
        • et al.
        Identification of high-risk plaques destined to cause acute coronary syndrome using coronary computed tomographic angiography and computational fluid dynamics.
        JACC Cardiovasc Imaging. 2019; 12: 1032-1043
        • Stone G.W.
        • Maehara A.
        • Lansky A.J.
        • et al.
        A prospective natural-history study of coronary atherosclerosis.
        N Engl J Med. 2011; 364: 226-235
        • Ahmadi A.
        • Argulian E.
        • Leipsic J.
        • Newby D.E.
        • Narula J.
        From subclinical atherosclerosis to plaque progression and acute coronary events: JACC state-of-the-art review.
        J Am Coll Cardiol. 2019; 74: 1608-1617
        • Ahmadi A.
        • Stone G.W.
        • Leipsic J.
        • et al.
        Association of coronary stenosis and plaque morphology with fractional flow reserve and outcomes.
        JAMA Cardiol. 2016; 1: 350-357
        • Ahmadi A.
        • Leipsic J.
        • Ovrehus K.A.
        • et al.
        Lesion-specific and vessel-related determinants of fractional flow reserve beyond coronary artery stenosis.
        JACC Cardiovasc Imaging. 2018; 11: 521-530
        • Ahmadi A.
        • Senoner T.
        • Correa A.
        • Feuchtner G.
        • Narula J.
        How atherosclerosis defines ischemia: atherosclerosis quantification and characterization as a method for determining ischemia.
        Journal of cardiovascular computed tomography. 2020; 14: 394-399
        • Bakhshi H.
        • Meyghani Z.
        • Kishi S.
        • et al.
        Comparative effectiveness of CT-derived atherosclerotic plaque metrics for predicting myocardial ischemia.
        JACC Cardiovasc Imaging. 2019; 12: 1367-1376
        • Kini A.S.
        • Baber U.
        • Kovacic J.C.
        • et al.
        Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy).
        J Am Coll Cardiol. 2013; 62: 21-29
        • Kini A.S.
        • Vengrenyuk Y.
        • Shameer K.
        • et al.
        Intracoronary imaging, cholesterol efflux, and transcriptomes after intensive statin treatment: the YELLOW II study.
        J Am Coll Cardiol. 2017; 69: 628-640
        • Maron D.J.
        • Hochman J.S.
        • Reynolds H.R.
        • et al.
        Initial invasive or conservative strategy for stable coronary disease.
        N Engl J Med. 2020; 382: 1395-1407
        • Driessen R.S.
        • Danad I.
        • Stuijfzand W.J.
        • et al.
        Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis.
        J Am Coll Cardiol. 2019; 73: 161-173
        • Johnson N.P.
        • Kirkeeide R.L.
        • Gould K.L.
        History and development of coronary flow reserve and fractional flow reserve for clinical applications.
        Interv Cardiol Clin. 2015; 4: 397-410
        • Johnson N.P.
        • Kirkeeide R.L.
        • Gould K.L.
        Same lesion, different artery, different FFR!?.
        JACC Cardiovasc Imaging. 2019 Apr; 12: 718-721
        • Yang D.H.
        • Kang S.J.
        • Koo H.J.
        • et al.
        Incremental value of subtended myocardial mass for identifying FFR-verified ischemia using quantitative CT angiography: comparison with quantitative coronary angiography and CT-FFR.
        JACC Cardiovasc Imaging. 2019 Apr; 12: 707-717
        • Patel M.R.
        • Norgaard B.L.
        • Fairbairn T.A.
        • et al.
        1-Year impact on medical practice and clinical outcomes of FFRCT: the ADVANCE registry.
        JACC Cardiovasc Imaging. 2020; 13: 97-105
        • Fairbairn T.A.
        • Nieman K.
        • Akasaka T.
        • et al.
        Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.
        Eur Heart J. 2018; 39: 3701-3711
        • Collet C.
        • Onuma Y.
        • Andreini D.
        • et al.
        Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease.
        Eur Heart J. 2018; 39: 3689-3698
        • Cook C.M.
        • Petraco R.
        • Shun-Shin M.J.
        • et al.
        Diagnostic accuracy of computed tomography-derived fractional flow reserve : a systematic review.
        JAMA Cardiol. 2017; 2: 803-810
        • Collet C.
        • Miyazaki Y.
        • Ryan N.
        • et al.
        Fractional flow reserve derived from computed tomographic angiography in patients with multivessel CAD.
        J Am Coll Cardiol. 2018; 71: 2756-2769
        • Ihdayhid A.R.
        • Norgaard B.L.
        • Gaur S.
        • et al.
        Prognostic value and risk continuum of noninvasive fractional flow reserve derived from coronary CT angiography.
        Radiology. 2019; 292: 343-351
        • Takagi H.
        • Ishikawa Y.
        • Orii M.
        • et al.
        Optimized interpretation of fractional flow reserve derived from computed tomography: comparison of three interpretation methods.
        J Cardiovasc Comput Tomogr. 2019; 13: 134-141
        • Coenen A.
        • Kim Y.H.
        • Kruk M.
        • et al.
        Diagnostic accuracy of a machine-learning approach to coronary computed tomographic angiography-based fractional flow reserve: result from the MACHINE consortium.
        Circ Cardiovasc Imaging. 2018 Jun; 11e007217
        • Kruk M.
        • Wardziak L.
        • Demkow M.
        • et al.
        Workstation-based calculation of CTA-based FFR for intermediate stenosis.
        J Am Coll Cardiol Img. 2016; 9: 690-699
        • Ko B.S.
        • Cameron J.D.
        • Munnur R.K.
        • et al.
        Noninvasive CT-derived FFR based on structural and fluid analysis: a comparison with invasive FFR for detection of functionally significant stenosis.
        J Am Coll Cardiol Img. 2017; 10: 663-673
        • Tang C.X.
        • Liu C.Y.
        • Lu M.J.
        • et al.
        CT FFR for ischemia-specific CAD with a new computational fluid dynamics algorithm: a Chinese multicenter study.
        JACC Cardiovasc Imaging. 2020 Apr; 13: 980-990
        • Kurata A.
        • Mochizuki T.
        • Koyama Y.
        • et al.
        Myocardial perfusion imaging using adenosine triphosphate stress multi-slice spiral computed tomography: alternative to stress myocardial perfusion scintigraphy.
        Circ J. 2005; 69: 550-557
        • Blankstein R.
        • Shturman L.D.
        • Rogers I.S.
        • et al.
        Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.
        J Am Coll Cardiol. 2009; 54: 1072-1084
        • Ko B.S.
        • Cameron J.D.
        • Meredith I.T.
        • et al.
        Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve.
        Eur Heart J. 2012; 33: 67-77
        • Bettencourt N.
        • Chiribiri A.
        • Schuster A.
        • et al.
        Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease.
        J Am Coll Cardiol. 2013; 61: 1099-1107
        • Greif M.
        • von Ziegler F.
        • Bamberg F.
        • et al.
        CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR.
        Heart. 2013; 99: 1004-1011
        • Feuchtner G.
        • Goetti R.
        • Plass A.
        • et al.
        Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging.
        Circ Cardiovasc Imaging. 2011; 4: 540-549
        • Rief M.
        • Zimmermann E.
        • Stenzel F.
        • et al.
        Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography.
        J Am Coll Cardiol. 2013; 62: 1476-1485
        • Rochitte C.E.
        • George R.T.
        • Chen M.Y.
        • et al.
        Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study.
        Eur Heart J. 2014; 35: 1120-1130
        • Kim S.M.
        • Chang S.A.
        • Shin W.
        • Choe Y.H.
        Dual-energy CT perfusion during pharmacologic stress for the assessment of myocardial perfusion defects using a second-generation dual-source CT: a comparison with cardiac magnetic resonance imaging.
        J Comput Assist Tomogr. 2014; 38: 44-52
        • De Cecco C.N.
        • Harris B.S.
        • Schoepf U.J.
        • et al.
        Incremental value of pharmacological stress cardiac dual-energy CT over coronary CT angiography alone for the assessment of coronary artery disease in a high-risk population.
        AJR Am J Roentgenol. 2014; 203: W70-W77
        • Ho K.T.
        • Chua K.C.
        • Klotz E.
        • Panknin C.
        Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT.
        JACC Cardiovasc Imaging. 2010; 3: 811-820
        • Bamberg F.
        • Becker A.
        • Schwarz F.
        • et al.
        Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging.
        Radiology. 2011; 260: 689-698
        • Goto Y.
        • Kitagawa K.
        • Uno M.
        • et al.
        Diagnostic accuracy of endocardial-to-epicardial myocardial blood flow ratio for the detection of significant coronary artery disease with dynamic myocardial perfusion dual-source computed tomography.
        Circ J. 2017; 81: 1477-1483
        • Wichmann J.L.
        • Meinel F.G.
        • Schoepf U.J.
        • et al.
        Absolute versus relative myocardial blood flow by dynamic CT myocardial perfusion imaging in patients with anatomic coronary artery disease.
        AJR Am J Roentgenol. 2015; 205: W67-W72
        • Huber A.M.
        • Leber V.
        • Gramer B.M.
        • et al.
        Myocardium: dynamic versus single-shot CT perfusion imaging.
        Radiology. 2013; 269: 378-386
        • Danad I.
        • Szymonifka J.
        • Schulman-Marcus J.
        • Min J.K.
        Static and dynamic assessment of myocardial perfusion by computed tomography.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 836-844
        • Lu M.
        • Wang S.
        • Sirajuddin A.
        • Arai A.E.
        • Zhao S.
        Dynamic stress computed tomography myocardial perfusion for detecting myocardial ischemia: a systematic review and meta-analysis.
        Int J Cardiol. 2018; 258: 325-331
        • Pontone G.
        • Andreini D.
        • Guaricci A.I.
        • et al.
        Incremental diagnostic value of stress computed tomography myocardial perfusion with whole-heart coverage CT scanner in intermediate- to high-risk symptomatic patients suspected of coronary artery disease.
        JACC Cardiovasc Imaging. 2019 Feb; 12: 338-349
        • Nakamura S.
        • Kitagawa K.
        • Goto Y.
        • et al.
        Incremental prognostic value of myocardial blood flow quantified with stress dynamic computed tomography perfusion imaging.
        JACC Cardiovasc Imaging. 2019; 12: 1379-1387
        • Yang J.
        • Dou G.
        • He B.
        • et al.
        Stress myocardial blood flow ratio by dynamic CT perfusion identifies hemodynamically significant CAD.
        JACC Cardiovasc Imaging. 2020 Apr; 13: 966-976
        • Yang D.H.
        • Kim Y.H.
        • Roh J.H.
        • et al.
        Diagnostic performance of on-site CT-derived fractional flow reserve versus CT perfusion.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 432-440
        • Coenen A.
        • Rossi A.
        • Lubbers M.M.
        • et al.
        Integrating CT myocardial perfusion and CT-FFR in the work-up of coronary artery disease.
        JACC Cardiovasc Imaging. 2017; 10: 760-770
        • Ronnow Sand N.P.
        • Nissen L.
        • Winther S.
        • et al.
        Prediction of coronary revascularization in stable Angina: comparison of FFRCT with CMR stress perfusion imaging.
        JACC Cardiovasc Imaging. 2019;
        • Sand N.P.R.
        • Veien K.T.
        • Nielsen S.S.
        • et al.
        Prospective comparison of FFR derived from coronary CT angiography with SPECT perfusion imaging in stable coronary artery disease: the ReASSESS study.
        JACC Cardiovasc Imaging. 2018; 11: 1640-1650
        • Nakamura S.
        • Kitagawa K.
        • Goto Y.
        • et al.
        Prognostic value of stress dynamic computed tomography perfusion with computed tomography delayed enhancement.
        JACC Cardiovasc Imaging. 2020 Aug; 13: 1721-1734
        • Bom M.J.
        • Driessen R.S.
        • Stuijfzand W.J.
        • et al.
        Diagnostic value of transluminal attenuation gradient for the presence of ischemia as defined by fractional flow reserve and quantitative positron emission tomography.
        JACC Cardiovasc Imaging. 2019 Feb; 12: 323-333
        • Pontone G.
        • Baggiano A.
        • Andreini D.
        • et al.
        Stress computed tomography perfusion versus fractional flow reserve CT derived in suspected coronary artery disease: the PERFECTION study.
        JACC Cardiovasc Imaging. 2019 Aug; 12: 1487-1497
        • Taylor A.J.
        • Cerqueira M.
        • Hodgson J.M.
        • et al.
        ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American College of Radiology, the American heart association, the American society of echocardiography, the American society of nuclear cardiology, the North American society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance.
        J Cardiovasc Comput Tomogr. 2010; 4: 407-433
        • Barbero U.
        • Iannaccone M.
        • d’Ascenzo F.
        • et al.
        64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: a meta-analysis.
        Int J Cardiol. 2016; 216: 52-57
        • Mushtaq S.
        • Conte E.
        • Pontone G.
        • et al.
        Interpretability of coronary CT angiography performed with a novel whole-heart coverage high-definition CT scanner in 300 consecutive patients with coronary artery bypass grafts.
        J Cardiovasc Comput Tomogr. 2019; https://doi.org/10.1016/j.jcct.2019.08.004
        • de Graaf F.R.
        • van Velzen J.E.
        • Witkowska A.J.
        • et al.
        Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting.
        Eur Radiol. 2011; 21: 2285-2296
        • Weustink A.C.
        • Nieman K.
        • Pugliese F.
        • et al.
        Diagnostic accuracy of computed tomography angiography in patients after bypass grafting: comparison with invasive coronary angiography.
        JACC Cardiovasc Imaging. 2009; 2: 816-824
        • Mushtaq S.
        • Andreini D.
        • Pontone G.
        • et al.
        Prognostic value of coronary CTA in coronary bypass patients: a long-term follow-up study.
        JACC Cardiovasc Imaging. 2014; 7: 580-589
        • Choi A.D.
        • Brar V.
        • Kancherla K.
        • et al.
        Prospective evaluation of cardiac CT in reoperative cardiac surgery.
        JACC Cardiovasc Imaging. 2016 Nov; 9: 1356-1357
        • Fihn S.D.
        • Gardin J.M.
        • Abrams J.
        • et al.
        ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of cardiology foundation/American heart association task force on practice guidelines, and the American College of physicians, American association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons.
        J Am Coll Cardiol. 2012; 60 (2012): e44-e164
        • Montalescot G.
        • Sechtem U.
        • Achenbach S.
        • et al.
        ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
        Eur Heart J. 2013; 34 (2013): 2949-3003
        • Hickethier T.
        • Wenning J.
        • Doerner J.
        • Maintz D.
        • Michels G.
        • Bunck A.C.
        Fourth update on CT angiography of coronary stents: in vitro evaluation of 24 novel stent types.
        Acta Radiol. 2018; 59 (284185117744227): 1060-1065
        • Dai T.
        • Wang J.R.
        • Hu P.F.
        Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis.
        Eur Radiol. 2018; 28: 1373-1382
        • Sun Z.
        • Almutairi A.M.
        Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: a meta-analysis.
        Eur J Radiol. 2010; 73: 266-273
        • Yang J.
        • Yang X.
        • De Cecco C.N.
        • et al.
        Iterative reconstruction improves detection of in-stent restenosis by high-pitch dual-source coronary CT angiography.
        Sci Rep. 2017; 7: 6956
        • Wan Y.L.
        • Tsay P.K.
        • Chen C.C.
        • et al.
        Coronary in-stent restenosis: predisposing clinical and stent-related factors, diagnostic performance and analyses of inaccuracies in 320-row computed tomography angiography.
        Int J Cardiovasc Imag. 2016; 32: 105-115
        • Tatsugami F.
        • Higaki T.
        • Sakane H.
        • et al.
        Diagnostic accuracy of in-stent restenosis using model-based iterative reconstruction at coronary CT angiography: initial experience.
        Br J Radiol. 2018; 91: 20170598
        • Geyer L.L.
        • Glenn G.R.
        • De Cecco C.N.
        • et al.
        CT evaluation of small-diameter coronary artery stents: effect of an integrated circuit detector with iterative reconstruction.
        Radiology. 2015; 276: 706-714
        • Eisentopf J.
        • Achenbach S.
        • Ulzheimer S.
        • et al.
        Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation.
        JACC Cardiovasc Imaging. 2013; 6: 458-465
        • Mangold S.
        • Cannao P.M.
        • Schoepf U.J.
        • et al.
        Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using third generation dual-source dual-energy CT: a phantom study.
        Eur Radiol. 2016; 26: 1871-1878
        • Hickethier T.
        • Baessler B.
        • Kroeger J.R.
        • et al.
        Monoenergetic reconstructions for imaging of coronary artery stents using spectral detector CT: in-vitro experience and comparison to conventional images.
        J Cardiovasc Comput Tomogr. 2017; 11: 33-39
        • Andreini D.
        • Mushtaq S.
        • Pontone G.
        • et al.
        CT perfusion versus coronary CT angiography in patients with suspected in-stent restenosis or CAD progression.
        JACC Cardiovasc Imaging. 2020 Mar; 13: 732-742
        • Braunwald E.
        • Jones R.H.
        • Mark D.B.
        • et al.
        Diagnosing and managing unstable angina. Agency for health care policy and research.
        Circulation. 1994; 90: 613-622
        • NICE
        Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin.
        CG95. NICE, 2010
        • Fihn S.D.
        • Blankenship J.C.
        • Alexander K.P.
        • et al.
        ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of cardiology/American heart association task force on practice guidelines, and the American association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons.
        Circulation. 2014; 130 (2014): 1749-1767
        • Knuuti J.
        • Wijns W.
        • Saraste A.
        • et al.
        ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39 (2019): 3322-3330
        • Genders T.S.
        • Steyerberg E.W.
        • Alkadhi H.
        • et al.
        A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension.
        Eur Heart J. 2011; 32: 1316-1330
        • Adamson P.D.
        • Hunter A.
        • Williams M.C.
        • et al.
        Diagnostic and prognostic benefits of computed tomography coronary angiography using the 2016 National Institute for Health and Care Excellence guidance within a randomised trial.
        Heart. 2018; 104: 207-214
        • NICE
        Resource Impact Report: HeartFlow FFRCT for Estimating Fractional Flow Reserve from Coronary CT Angiography (MTG32).
        2017
        • Foldyna B.
        • Udelson J.E.
        • Karady J.
        • et al.
        Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial.
        Eur Heart J Cardiovasc Imaging. 2019; 20: 574-581
        • Newby D.E.
        • Adamson P.D.
        • Berry C.
        • et al.
        Coronary CT angiography and 5-year risk of myocardial infarction.
        N Engl J Med. 2018; 379: 924-933
        • Norgaard B.L.
        • Terkelsen C.J.
        • Mathiassen O.N.
        • et al.
        Coronary CT angiographic and flow reserve-guided management of patients with stable ischemic heart disease.
        J Am Coll Cardiol. 2018; 72: 2123-2134
        • Sharma A.
        • Coles A.
        • Sekaran N.K.
        • et al.
        Stress testing versus CT angiography in patients with diabetes and suspected coronary artery disease.
        J Am Coll Cardiol. 2019; 73: 893-902
        • Opolski M.P.
        • Staruch A.D.
        • Jakubczyk M.
        • et al.
        CT angiography for the detection of coronary artery stenoses in patients referred for cardiac valve surgery: systematic review and meta-analysis.
        JACC Cardiovasc Imaging. 2016; 9: 1059-1070
        • Andreini D.
        • Pontone G.
        • Mushtaq S.
        • et al.
        Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement.
        Am Heart J. 2014; 168: 332-339
        • Rossi A.
        • Dharampal A.
        • Wragg A.
        • et al.
        Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions?.
        Eur Heart J Cardiovasc Imaging. 2014; 15: 85-94
        • Andreini D.
        • Magnoni M.
        • Conte E.
        • et al.
        Coronary plaque features on CTA can identify patients at increased risk of cardiovascular events.
        JACC Cardiovasc Imaging. 2020; 13: 1704-1717
        • Fleisher L.A.
        • Fleischmann K.E.
        • Auerbach A.D.
        • et al.
        ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of cardiology/American heart association task force on practice guidelines. Developed in collaboration with the American College of surgeons, American society of anesthesiologists, American society of echocardiography, American society of nuclear cardiology, heart rhythm society, society for cardiovascular angiography and interventions, society of cardiovascular anesthesiologists, and society of vascular medicine endorsed by the society of hospital medicine.
        J Nucl Cardiol. 2014; 22 (2015): 162-215
        • Hwang J.W.
        • Kim E.K.
        • Yang J.H.
        • et al.
        Assessment of perioperative cardiac risk of patients undergoing noncardiac surgery using coronary computed tomographic angiography.
        Circ Cardiovasc Imaging. 2015; 8
        • Ahn J.H.
        • Park J.R.
        • Min J.H.
        • et al.
        Risk stratification using computed tomography coronary angiography in patients undergoing intermediate-risk noncardiac surgery.
        J Am Coll Cardiol. 2013; 61: 661-668
        • Imran Hamid U.
        • Digney R.
        • Soo L.
        • Leung S.
        • Graham A.N.
        Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning.
        Eur J Cardio Thorac Surg. 2015; 47: 819-823
        • Maluenda G.
        • Goldstein M.A.
        • Lemesle G.
        • et al.
        Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.
        Am Heart J. 2010; 159: 301-306
        • Goldstein M.A.
        • Roy S.K.
        • Hebsur S.
        • et al.
        Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.
        Int J Cardiovasc Imag. 2013; 29: 709-717
        • Kalisz K.
        • Rajiah P.
        Computed tomography of cardiomyopathies.
        Cardiovasc Diagn Ther. 2017; 7: 539-556
        • Andreini D.
        • Pontone G.
        • Pepi M.
        • et al.
        Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardlomyopathy.
        J Am Coll Cardiol. 2007; 49: 2044-2050
        • Bhatti S.
        • Hakeem A.
        • Yousuf M.A.
        • Al-Khalidi H.R.
        • Mazur W.
        • Shizukuda Y.
        Diagnostic performance of computed tomography angiography for differentiating ischemic vs nonischemic cardiomyopathy.
        J Nucl Cardiol : official publication of the American Society of Nuclear Cardiology. 2011; 18: 407-420
        • Lee H.J.
        • Im D.J.
        • Youn J.C.
        • et al.
        Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: a prospective comparison with delayed enhancement cardiac magnetic resonance imaging.
        Int J Cardiovasc Imag. 2017; 33: 577-584
        • Aikawa T.
        • Oyama-Manabe N.
        • Naya M.
        • et al.
        Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: a feasibility study.
        Eur Radiol. 2017; 27: 4054-4063
        • Deux J.F.
        • Mihalache C.I.
        • Legou F.
        • et al.
        Noninvasive detection of cardiac amyloidosis using delayed enhanced MDCT: a pilot study.
        Eur Radiol. 2015; 25: 2291-2297
        • Kim R.J.
        • Wu E.
        • Rafael A.
        • et al.
        The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.
        N Engl J Med. 2000; 343: 1445-1453
        • Vliegenthart R.
        • Henzler T.
        • Moscariello A.
        • et al.
        CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability.
        AJR Am J Roentgenol. 2012; 198: 531-547
        • Brodoefel H.
        • Klumpp B.
        • Reimann A.
        • et al.
        Late myocardial enhancement assessed by 64-MSCT in reperfused porcine myocardial infarction: diagnostic accuracy of low-dose CT protocols in comparison with magnetic resonance imaging.
        Eur Radiol. 2007; 17: 475-483
        • Mahnken A.H.
        • Bruners P.
        • Muhlenbruch G.
        • et al.
        Low tube voltage improves computed tomography imaging of delayed myocardial contrast enhancement in an experimental acute myocardial infarction model.
        Invest Radiol. 2007; 42: 123-129
        • Blankstein R.
        • Rogers I.S.
        • Cury R.C.
        Practical tips and tricks in cardiovascular computed tomography: diagnosis of myocardial infarction.
        J Cardiovasc Comput Tomogr. 2009; 3: 104-111
        • Rodriguez-Granillo G.A.
        • Campisi R.
        • Deviggiano A.
        • et al.
        Detection of myocardial infarction using delayed enhancement dual-energy CT in stable patients.
        AJR Am J Roentgenol. 2017; 209: 1023-1032
        • Gerber B.L.
        • Belge B.
        • Legros G.J.
        • et al.
        Characterization of acute and chronic myocardial infarcts by multidetector computed tomography: comparison with contrast-enhanced magnetic resonance.
        Circulation. 2006; 113: 823-833
        • Nieman K.
        • Shapiro M.D.
        • Ferencik M.
        • et al.
        Reperfused myocardial infarction: contrast-enhanced 64-Section CT in comparison to MR imaging.
        Radiology. 2008; 247: 49-56
        • Choe Y.H.
        • Choo K.S.
        • Jeon E.S.
        • Gwon H.C.
        • Choi J.H.
        • Park J.E.
        Comparison of MDCT and MRI in the detection and sizing of acute and chronic myocardial infarcts.
        Eur J Radiol. 2008; 66: 292-299
        • Jacquier A.
        • Boussel L.
        • Amabile N.
        • et al.
        Multidetector computed tomography in reperfused acute myocardial infarction. Assessment of infarct size and no-reflow in comparison with cardiac magnetic resonance imaging.
        Invest Radiol. 2008; 43: 773-781
        • Boussel L.
        • Ribagnac M.
        • Bonnefoy E.
        • et al.
        Assessment of acute myocardial infarction using MDCT after percutaneous coronary intervention: comparison with MRI.
        AJR Am J Roentgenol. 2008; 191: 441-447
        • Habis M.
        • Capderou A.
        • Sigal-Cinqualbre A.
        • et al.
        Comparison of delayed enhancement patterns on multislice computed tomography immediately after coronary angiography and cardiac magnetic resonance imaging in acute myocardial infarction.
        Heart. 2009; 95: 624-629
        • Zafar H.M.
        • Litt H.I.
        • Torigian D.A.
        CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction.
        Clin Radiol. 2008; 63: 256-262
        • Costanzo M.R.
        • Dipchand A.
        • Starling R.
        • et al.
        The international society of heart and lung transplantation guidelines for the care of heart transplant recipients.
        J Heart Lung Transplant. 2010; 29: 914-956
        • Stehlik J.
        • Edwards L.B.
        • Kucheryavaya A.Y.
        • et al.
        The registry of the international society for heart and lung transplantation: 29th official adult heart transplant report--2012.
        J Heart Lung Transplant. 2012; 31: 1052-1064
        • Ferencik M.
        • Brady T.J.
        • Hoffmann U.
        Computed tomography imaging of cardiac allograft vasculopathy.
        J Cardiovasc Comput Tomogr. 2012; 6: 223-231
        • Wever-Pinzon O.
        • Romero J.
        • Kelesidis I.
        • et al.
        Coronary computed tomography angiography for the detection of cardiac allograft vasculopathy: a meta-analysis of prospective trials.
        J Am Coll Cardiol. 2014; 63: 1992-2004
        • Shi H.
        • Aschoff A.J.
        • Brambs H.J.
        • Hoffmann M.H.
        Multislice CT imaging of anomalous coronary arteries.
        Eur Radiol. 2004; 14: 2172-2181
        • Datta J.
        • White C.S.
        • Gilkeson R.C.
        • et al.
        Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography.
        Radiology. 2005; 235: 812-818
        • Dodd J.D.
        • Ferencik M.
        • Liberthson R.R.
        • et al.
        Congenital anomalies of coronary artery origin in adults: 64-MDCT appearance.
        AJR Am J Roentgenol. 2007; 188: W138-W146
        • Cheezum M.K.
        • Ghoshhajra B.
        • Bittencourt M.S.
        • et al.
        Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 224-235
        • Opolski M.P.
        • Pregowski J.
        • Kruk M.
        • et al.
        Prevalence and characteristics of coronary anomalies originating from the opposite sinus of Valsalva in 8,522 patients referred for coronary computed tomography angiography.
        Am J Cardiol. 2013; 111: 1361-1367
      1. ACR–NASCI–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF CARDIAC COMPUTED TOMOGRAPHY (CT).
        • Hecht H.S.
        • Cronin P.
        • Blaha M.J.
        • et al.
        Erratum to "2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans a report of the society of Cardiovascular Computed Tomography and Society of Thoracic Radiology".
        J. Cardiovasc. Comput. Tomogr. 2017; 11 (J Cardiovasc Comput Tomogr. 2017;11(2):170): 74-84
        • Hecht H.S.
        • Narula J.
        • Leipsic J.
        It’s in the field of view! Coronary artery analysis on chest computed tomographic angiography.
        Circ Res. 2018; 122: 402-404
        • Pathan F.
        • Hecht H.
        • Narula J.
        • Marwick T.H.
        Roles of transesophageal echocardiography and cardiac computed tomography for evaluation of left atrial thrombus and associated pathology: a review and critical analysis.
        JACC Cardiovasc Imaging. 2018; 11: 616-627
        • Hwang J.J.
        • Chen J.J.
        • Lin S.C.
        • et al.
        Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations.
        Am J Cardiol. 1993; 72: 677-681
        • Romero J.
        • Husain S.A.
        • Kelesidis I.
        • Sanz J.
        • Medina H.M.
        • Garcia M.J.
        Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis.
        Circ Cardiovasc Imaging. 2013; 6: 185-194
        • Bilchick K.C.
        • Mealor A.
        • Gonzalez J.
        • et al.
        Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation.
        Heart Rhythm. 2016; 13: 12-19
        • Alli O.
        • Asirvatham S.
        • Holmes Jr., D.R.
        Strategies to incorporate left atrial appendage occlusion into clinical practice.
        J Am Coll Cardiol. 2015; 65: 2337-2344
        • McClelland R.L.
        • Jorgensen N.W.
        • Budoff M.
        • et al.
        10-Year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (Multi-Ethnic study of atherosclerosis) with validation in the HNR (heinz nixdorf recall) study and the DHS (dallas heart study).
        J Am Coll Cardiol. 2015; 66: 1643-1653
        • Cury R.C.
        • Abbara S.
        • Achenbach S.
        • et al.
        Coronary artery disease - reporting and data system (CAD-RADS): an expert consensus document of SCCT, ACR and NASCI: endorsed by the ACC.
        JACC Cardiovasc Imaging. 2016; 9: 1099-1113
        • Bittner D.O.
        • Mayrhofer T.
        • Budoff M.
        • et al.
        Prognostic value of coronary CTA in stable chest pain: CAD-RADS, CAC, and cardiovascular events in PROMISE.
        JACC Cardiovasc Imaging. 2019;
        • Honigberg M.C.
        • Lander B.S.
        • Baliyan V.
        • et al.
        Preventive management of nonobstructive CAD after coronary CT angiography in the emergency department.
        JACC Cardiovasc Imaging. 2020; 13: 437-448
        • Mangion K.
        • Adamson P.D.
        • Williams M.C.
        • et al.
        Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain.
        Eur Heart J. 2020 Apr 1; 41: 1337-1345
        • Fairbaim T.A.
        • Dobson R.
        • Hurwitz-Koweek L.
        • et al.
        Sex differences in coronary computed tomography angiography–derived fractional flow reserve: lessons from ADVANCE.
        J Am Coll Cardiol Img. 2020; 13: 2576-2587
        • Mortensen M.B.
        • Steffensen F.H.
        • Bøtker H.E.
        • et al.
        CAD severity on cardiac CTA identifies patients with most benefit of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets.
        JACC Cardiovasc Imaging. 2020 Sep; 13: 1961-1972
        • Norgaard B.L.
        • Hjort J.
        • Gaur S.
        • et al.
        Clinical use of coronary CTA-derived FFR for decision-making in stable CAD.
        JACC Cardiovasc Imaging. 2017; 10: 541-550
        • Nissen L.
        • Winther S.
        • Westra J.
        • et al.
        Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy.
        Eur Heart J Cardiovasc Imaging. 2018; 19: 369-377
        • Budoff M.J.
        • Mayrhofer T.
        • Ferencik M.
        • et al.
        Prognostic value of coronary artery calcium in the PROMISE study (prospective multicenter imaging study for evaluation of chest pain).
        Circulation. 2017; 136: 1993-2005
        • Douglas P.S.
        • Pontone G.
        • Hlatky M.A.
        • et al.
        Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study.
        Eur Heart J. 2015; 36: 3359-3367
        • Curzen N.P.
        • Nolan J.
        • Zaman A.G.
        • Norgaard B.L.
        • Rajani R.
        Does the routine availability of CT-derived FFR influence management of patients with stable chest pain compared to CT angiography alone?: the FFRCT RIPCORD study.
        JACC Cardiovasc Imaging. 2016; 9: 1188-1194
        • Lu M.T.
        • Ferencik M.
        • Roberts R.S.
        • et al.
        Noninvasive FFR derived from coronary CT angiography: management and outcomes in the PROMISE trial.
        JACC Cardiovasc Imaging. 2017; 10: 1350-1358
        • Douglas P.S.
        • De Bruyne B.
        • Pontone G.
        • et al.
        1-Year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM study.
        J Am Coll Cardiol. 2016; 68: 435-445
        • Shaw L.J.
        • Blankstein R.
        • Brown D.L.
        • et al.
        Controversies in diagnostic imaging of patients with suspected stable and acute chest pain syndromes.
        JACC Cardiovasc Imaging. 2019; 12: 1254-1278
        • Stocker T.J.
        • Leipsic J.
        • Hadamitzky M.
        • et al.
        Application of low tube potentials in CCTA: results from the PROTECTION VI study.
        JACC Cardiovasc Imaging. 2020; 13: 425-434