# Coronary CT angiography (CCTA)

Coronary CT angiography (CCTA) is a CT scan that, with an iodine contrast dye in your vein, builds a 3D picture of your heart's arteries. It shows both how narrow an artery is and what the plaque is made of, including soft, lipid-rich plaque that a plain calcium scan cannot see. In the SCOT-HEART trial (4,146 people), care guided by CCTA cut heart-disease death or non-fatal heart attack by 41% over five years versus standard care, largely by reclassifying risk and starting prevention earlier. Modern scans use a low radiation dose of about 1 to 5 mSv, much less than older protocols. An add-on called CT-FFR can even judge whether a narrowing actually starves the heart of blood, without an invasive catheter. CCTA is not the same as a coronary artery calcium (CAC) score: CAC only counts hardened, calcified plaque, while CCTA reveals the full picture, including the soft, non-calcified disease.

## Sources

- Bittner DO, Mayrhofer T, Budoff M, et al.. (2020). Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, Coronary Artery Calcium, and Cardiovascular Events in the PROMISE Trial. JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2019.09.012
- Newby DE, Adamson PD, Berry C, et al.. (2018). Coronary CT Angiography and 5-Year Risk of Myocardial Infarction (SCOT-HEART). New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1805971

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