Coronary CT Angiography in 2025: Long-Term Evidence, Artificial Intelligence, and the Photon-Counting Era

Coronary CT Angiography (CCTA) has become established as a first-line test in the evaluation of chest pain, supported by robust evidence of prognostic impact, advances in Artificial Intelligence (AI), and technological evolution with photon-counting CT. Publications in 2025 reposition CCTA as a central platform for risk stratification and therapeutic guidance in coronary artery disease.

The 10-year follow-up of the SCOT-HEART trial represents a major milestone in this process. Among 4,146 patients with stable chest pain randomized to standard care with or without CCTA, there was a sustained reduction in death from coronary heart disease or nonfatal myocardial infarction in the CCTA-guided group (HR 0.79; 95% CI 0.63–0.99). Although revascularization rates did not differ between groups, the use of preventive therapies was more intensive and consistently maintained over time in the CCTA arm. These findings demonstrate that the direct identification of atherosclerosis leads to more aggressive preventive interventions, with durable effects on clinical outcomes, establishing CCTA as a disease-modifying tool in chronic coronary syndromes.

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