In this episode, Dr Jonathon Leipsic (University of British Columbia, Vancouver, British Columbia, Canada) is joined by Dr Gianluca Pontone (Centro Cardiologico Monzino IRCCS, Milan, Italy) to discuss how the continued emphasis on CCTA as a first-line test will influence clinical practice, and summarise the considerations for integrating non-invasive diagnostics into routine care.

Here, Dr Carlos Collet (Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium) provides insight into why the guidelines have once again recommended CT as the first line test for patients with chest pain. In addition, he notes that for understanding the presence or absence of CAD, the availability of CT is crucial in determining the investigative journey of patients.

In this episode, Dr Bernard De Bruyne (Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium) opines that CCTA as a first line test will have major impact on the flow of patients and thus on the practise of most clinical cardiologists. He also asserts that FFRCT has a significant role to play – even more so than invasive FFR – to complement a coronary angiogram.

Prof Patrick Serruys (University of Galway, Ireland) highlights the importance of the concept of the ‘one-stop-shop’ for CCTA with FFRCR. He notes the value for physicians to have one test for multiple responses, circumventing the need for a high number of isolated tests – exercise, thallium scintigraphy and dobutamine – to provide timely and definitive guidance for treatment strategies.

Prof Daniele Andreini (IRCCS Galeazzi-Sant'Ambrogio, Milan, Italy) notes that in the ESC guidelines, cardiac CT (in line with the ACC 2021 guidelines) has been recommended as 1A for suspected coronary artery disease, including for patients at low-risk (5-15%). He comments that this aligns with a trend over the last 5-10 years for cardiac CT to be a valuable screening test for select patient populations.

In this interview, Dr Tim Fairbairn (Liverpool Heart and Chest Hospital, UK) discusses the FISH&CHIPS study, which assessed the national rollout of FFRCT for stable coronary artery disease. Among 90,000+ patients, incorporating FFRCT into CCTA reduced unnecessary invasive angiograms and follow-up tests without compromising safety. This improved diagnostic certainty, streamlined resource use, and enabled more personalised care. The findings underscore the value of AI-driven diagnostics at scale.