Expanding the indications of coronary computed tomography angiography to patients with complex coronary artery disease

Computed tomography technology has vastly improved over the past decades. The performance of coronary CT angiography has been enhanced allowing for the expansion to more complex patients subsets. In addition, blood flow simulations derived from coronary CT angiography provide a physiologic assessment of the entire coronary tree in the non-invasive setting. In this thesis, we expanded the indications of coronary CT angiography to patients with known coronary artery disease (CAD). Fractional flow reserve derived from CT (FFRCT) was validated in patients with multivessel CAD and demonstrated an excellent diagnostic performance to detect hemodynamically significant stenosis. Furthermore, the use of the FFRCT technology proved to be instrumental in understanding the atherosclerotic process and the impact of vessel remodeling on functional parameters. Coronary CT angiography was accurate in the assessment of the presence, extension, severity and physiological effects of CAD. Finally, the SYNTAX III Revolution trial showed high level of agreement in clinical-decision making between percutaneous coronary interventions and coronary artery bypass grafting derived either from a non-invasive or an invasive diagnostic strategy. The present thesis supports the expansion of coronary CT angiography and FFRCT to patients with complex coronary artery disease.