Cronicon OPEN ACCESS EC CARDIOLOGY Short Communication Computed Tomography Coronary Angiography (CTCA) and its Non-invasive Role in Stable Coronary Artery Disease Han Naung Tun 1,2 * and Syed Haseeb Raza Naqvi 3 1 Council on Clinical Practice, Clinical and Research Working Groups, European Society of Cardiology, France 2 National Representative of Heart Failure Specialist of Tomorrow for Myanmar in European Heart Failure Association, European Society of Cardiology, France 3 Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan Citation: Han Naung Tun., et al. “Computed Tomography Coronary Angiography (CTCA) and its Non-invasive Role in Stable Coronary Artery Disease”. EC Cardiology 6.11 (2019): 49-50. *Corresponding Author: Han Naung Tun, Council on Clinical Practice, Clinical and Research Working Groups, European Society of Cardiology and National Representative of Heart Failure Specialist of Tomorrow for Myanmar in European Heart Failure Association, European Society of Cardiology, France. Received: September 30, 2019; Published: October 17, 2019 Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial ar- teries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). CTCA uses computed tomography (CT) scanning to take images (angiograms) of the coronary arteries. It requires the use of rapid CT scanning techniques and can only be carried out in centers where the equipment is suitable and the medical/technology staffs are trained appropriately. Computed Tomography Coronary Angiography is the preferred test in patients with a lower range of clinical likelihood of CAD, no previous diagnosis of CAD, and characteristics associated with a high likelihood of good image quality. It detects subclinical coronary ath- erosclerosis but can also accurately rule out both anatomically and functionally significant CAD. Its higher accuracy values of CTCA when low clinical likelihood populations are subjected to examination [1]. Trials evaluating outcomes after coronary CTA to date have mostly included patients with a low clinical likelihood [2,3]. The non-invasive functional tests for ischaemia typically have better rule-in power. In outcome trials, functional imaging tests have been associated with fewer referrals for downstream ICA compared with a strategy relying on anatomical imaging [4,5]. Functional evalu- ation of ischaemia (either non-invasive or invasive) is required in most patients before revascularization decisions can be made. There- fore, non-invasive functional testing has now come to be preferred in patients at the higher end of the range of clinical likelihood if revas- cularization is likely or the patient has previously diagnosed CAD. If CAD is suspected in patients, but who have a very low clinical likelihood (≤ 5%) of CAD, should have other cardiac causes of chest pain excluded and their cardiovascular risk factors adjusted, based on a risk-score assessment. In patients with repeated, unprovoked at- tacks of anginal symptoms mainly at rest, vasospastic angina should be considered, diagnosed, and treated appropriately In addition to diagnostic accuracy and clinical likelihood, the selection of a non-invasive test depends on other patient characteristics, local expertise, and the availability of tests. Some diagnostic tests may perform better in some patients than others. For example, irregular heart rate and the presence of extensive coronary calcification are associated with increased likelihood of non-diagnostic image quality of CTCA and it is not recommended in such patients [1]. Stress echocardiography or SPECT perfusion imaging can be combined with