The imaging of coronary artery disease

The current ‘gold standard’ investigation of coronary atherosclerosis is invasive coronary angiography. In the UK, more than 250,000 cardiac catheterizations are performed each year. Less than 40% of these are percutaneous interventional procedures and many patients are found to have normal coronaries or only minimal disease. During cardiac catheterization, a single investigation can establish diagnosis and allow therapeutic intervention, but as with any invasive procedure there are small, associated risks. Development of a non-invasive coronary imaging strategy has the potential to reduce the number of patients undergoing invasive procedures without need for intervention. Here we consider the utility of current imaging modalities for evaluation of structural arterial disease and cardiovascular risk assessment, focusing on multi-slice computed tomography (MSCT) as a potential alternative to diagnostic angiography.