Abstract
Coronary computed tomography angiography (CCTA) can be used beyond diagnostic purposes to support the preprocedural planning of percutaneous coronary intervention (PCI). Advances in scanner technology, software platforms, and physiology- and plaque-based visualization tools have expanded the role of CCTA-guided PCI. CCTA provides detailed assessment of coronary anatomy, plaque and calcium morphology, lesion length, vessel size, and noninvasive physiology, offering opportunities to anticipate procedural complexity, optimize resource utilization, and individualize PCI strategy. Emerging data, including randomized studies in chronic total occlusions and ongoing multicenter trials, support the feasibility and potential clinical value of this approach. In April 2024, the first CCTA-guided PCI summit in the United States convened interventional cardiologists and cardiac imagers, as well as industry stakeholders, to discuss the evidence, technical considerations, clinical applications, and unmet needs related to CCTA-guided PCI. This manuscript summarizes the key discussions and conclusions specific to this meeting, with a focus on the transition of CCTA from a diagnostic to a therapeutic planning tool, emerging artificial intelligence applications, its complementary role with intravascular imaging, and opportunities to enhance procedural planning and decision-making. While early experience is promising, broader adoption will require broader educational efforts, access to purpose-built visualization software tools designed for interventional cardiologists, multidisciplinary collaboration, and additional randomized and real-world studies to define its impact on clinical outcomes and procedural efficiency.