Clinical utility of coronary CT angiography to guide PCI: a survey among P4 investigators

Background: Coronary CT Angiography (CTA) is increasingly being used to plan percutaneous coronary intervention (PCI), offering detailed pre-procedural anatomical and physiological insights. The Precise Procedural and PCI Plan (P4) study evaluates the efficacy of CT- versus intravascular ultrasound-guided PCI. The aim of this study was to assess the utility of various CT-guided PCI tools and strategies as perceived by experienced operators within the context of the P4 study. Methods: A cross-sectional survey was conducted among 25 operators who participate in the P4 trial from multiple international centers. Participants were asked to evaluate the utility of pre-procedural CTA planning, physiological information with virtual PCI, and online guidance. The survey included multiple-choice, Likert scale, and ranking questions. Results: Most respondents valued pre-procedural planning highly (average score 2.83/3), particularly for the assessment of plaque composition and calcium characterization. Plaque composition evaluation, including calcium analysis, was ranked as the most valued factor, with an average usefulness score of 6.13/7. Calcium arc information was rated as the most useful component of calcium analysis (4/5 rating). The survey highlighted the importance of myocardial mass at risk assessment in bifurcation PCI and pointed to the anticipation of calcium density as a key future aspect of CT-guided PCI procedures. Conclusions: The integration of CT-guided PCI promises to refine procedural planning and to pave the way for a new standard of care in patients with stable CAD.