Synopsis
Select, prepare, interpret and act on CT coronary angiography while separating coronary anatomy from ischaemic significance and recognising non-diagnostic or urgent findings.
- CTCA is an anatomical test that shows coronary plaque, luminal narrowing, anomalous origins and selected extracoronary structures.
- For stable typical or atypical angina without established coronary disease, NICE recommends 64-slice or higher CTCA as the diagnostic imaging test.
- Good acquisition needs a stable rhythm, limited coronary motion, adequate contrast delivery and an appropriate radiation protocol tailored to the patient.
Key red flags
Current chest pain with haemodynamic instability, dynamic ischaemic ECG change or suspected myocardial infarction needs emergency assessment rather than routine CTCA preparation.
A suspected left main stenosis, severe multivessel disease or acute coronary occlusion on CTCA requires prompt direct communication and cardiology review.
A scan showing an important non-coronary emergency, such as acute aortic syndrome or major pulmonary embolic disease within the imaged field, must trigger immediate escalation.
Severe contrast reaction, sustained arrhythmia or clinical deterioration during acquisition requires stopping the examination and applying the department's emergency response.
Focal or diffuse luminal narrowing should be described by artery, segment and severity. Anatomical importance rises with left main, proximal or multivessel involvement, but functional significance is not inferred from appearance alone when uncertainty remains.
Define origin, proximal course, dominance and any interarterial or intramural relationship. Clinical importance depends on the exact anatomy, symptoms and evidence of ischaemia, not merely the word anomaly.
Review the aorta, valves, pericardium, lungs and mediastinum within the reconstructed field. Report consequential abnormalities through an agreed pathway while avoiding overcalling benign findings from a limited cardiac acquisition.
Investigation priorities
Define coronary plaque, lumen, origins and course in a diagnostic-quality anatomical study.
Management branches
Recent-onset stable chest discomfort remains typical or atypical angina, or non-anginal pain has relevant resting ECG changes.
- Document pain typicality, cardiovascular history, risk factors, resting ECG and whether coronary disease is already established.
- Check renal function, previous contrast reaction, pregnancy possibility, rhythm, heart rate and ability to cooperate with breath holding.