‘A defining moment’: How cardiologists can get the most out of CT-guided PCI
Using coronary CT angiography (CCTA) images to plan ahead for percutaneous coronary intervention (PCI) is associated with considerable benefits, including improved clarity about the patient’s anatomy, shorter procedure times and smaller radiation doses. However, its use among today’s interventional cardiologists has remained limited.
To help combat that trend, the Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Cardiovascular Computed Tomography (SCCT) have collaborated on a new clinician resource designed to get more interventional cardiologists to embrace CT-guided PCI going forward.
The document, “Coronary Computed Tomography Angiography to Guide Percutaneous Coronary Intervention: Expert Opinion from a SCAI/SCCT Roundtable,” was published in full in JSCAI and includes detailed recommendations that originate from a multidisciplinary roundtable SCAI and SCCT held back in October 2024.[1]
“Many patients already undergo coronary CT as part of their workup,” roundtable chair Yader Sandoval, MD, an interventional cardiologist at Minneapolis Heart Institute, said in a statement. “Our goal is to use that existing data to plan procedures more intelligently, reduce complications, and deliver more precise care. This was more than just a conversation—it was a convergence of specialties. We had imagers who’ve read hundreds of thousands of scans, and interventionalists who do complex PCI every day, sitting side by side. And the goal was singular: improve outcomes by leveraging the CT scans we’re already performing.”
CCTA’s impact on modern healthcare continues to grow
CCTA has been growing more and more popular for years now, providing care teams with a noninvasive way to evaluate heart patients for a long list of potential complications. The modality was once used more as a gatekeeper—abnormal results would simply trigger physicians to order additional imaging. Now, however, CCTA offers a detailed look at the patient’s coronaries, including any worrisome plaques that may require treatment.
Along the way, CCTA has earned class 1A recommendations in guidelines developed by the European Society of Cardiology, American College of Cardiology, American Heart Association and other leading medical societies. In addition, the U.S. Centers for Medicare and Medicaid Services (CMS) finalized a new payment policy in 2024 that more than doubled the Medicare reimbursements hospitals receive for performing CCTA. U.S. cardiologists and imaging specialists cheered the news, knowing it would now be easier than ever to use cardiac CT when appropriate.
In addition, artificial intelligence companies have started focusing more and more on the potential of CCTA, developing new software that can evaluate a patient’s imaging results and provide immediate recommendations related to the presence of high-risk plaques or other potentially harmful findings.
As this momentum has continued to grow, interventional cardiologists have also started turning to CCTA to plan ahead prior to PCI. This new document from SCAI and SCCT was created with this very practice in mind. By spreading the word about the benefits of this practice, the authors hopes to improve implementation and ensure specialists who do turn to CT-guided PCI are able to get the most value possible out of the experience.
Patient undergoes a cardiac CT scan with IV contrast at Wellstar Kennestone Hospital in Marietta, Georgia. Photo by Dave Fornell.
Discussing real-world applications of CT-guided PCI
The team that crafted this new document believe it helps address an unmet need. There are many potential benefits of CT-guided PCI—and educating cardiology and radiology specialists alike about these benefits is a needed step if the implementation of this technology is going to increase. The document’s authors also provided specific recommendations on how to extract key details from CCTA images and use those details to deliver better PCI outcomes.
“This wasn’t just an academic exercise—it was practical and forward-looking,” contributing author Carlos Collet, MD, PhD, an interventional cardiologist at OLV Clinic in Aalst, Belgium, explained. “We discussed real-world applications: How do I look at a CT and know the plaque morphology? How do I estimate vessel size or predict wire path through a complex occlusion? This document translates those answers into step-by-step guidance.”
“CT has long been foundational to planning structural heart interventions, where collaboration is baked into the workflow,” added Jonathon Leipsic, MD, co-chair of the roundtable and a radiologist at St. Paul’s Hospital in Vancouver, British Columbia. “Now we’re applying that same philosophy to coronary disease. This document outlines current evidence and future opportunities, and importantly, it helps democratize the field. You don’t have to be a CT expert to start using these tools. We’re giving people a guide to get on the escalator—wherever they are—and move upward.”
One of the biggest takeaways from the new document is how important it is for interventionalists and imaging specialists to work together. Many interventional cardiologists have little prior experience interpreting CCTA images, for example, and it may take hands-on training and a lot of practice for that to change.
“This is a defining moment for interventional cardiology,” Leipsic said. “We know we can improve patient outcomes by planning better. CT helps us do that. Now we have a playbook.”
Read the full expert opinion here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.