Indications for CCTA:

  1. low to intermediate risk CAD and atypical chest pain

 a) Use of CCTA for CAD detection in patients with stable chest pain without known CAD:

          -ECG interpretable AND able to exercise with intermediate risk probability

          -ECG uninterpretable OR unable to exercise with low and intermediate risk prob.

           b) Use of CCTA for CAD detection in patients with stable chest pain and prior test results:

          -Discordant ECG exercise AND imaging results

          -Equivocal stress imaging procedure


  1. Symptomatic patients with new HFrEF OR prior to cardiac surgery:

         -Low to intermediate risk prob in HFrEF

         -Non-coronary cardiac surgery for an intermediate-risk problem


  1. Left main patency if stent of 3 mm or > even in ASYMPTOMATIC
  2. Bypass graft patency in symptomatic patients
  3. Detection of CAD in Acute Chest Pain: low to intermediate risk prob is appropriate unless High Pretest Probability, abnormal ECG or Biomarkers!
  4. Pulmonary vein mapping
  5. Pre-TAVR (scans of both heart and entire aorta; coronary height 10-14 mm; valve sizing; vascular access planning)
  6. Coronary Anomalies
  7. CTOs – CTA can provide info on occlusion length, calcification, and tortuosity which assist in procedural planning.


HR needs to be 60 bpm so prescribing metoprolol succinate the night prior x1 tablet helps facilitate a lower heart rate to decrease coronary artery motion.

Avoid scanning coronaries in patients with atrial fibrillation, BMI >40, calcium score >400, stents (except LM > or equal to 3 mm) and eGFR <30.