The Role of Computed Tomography Cardiac Imaging in Risk Stratification of Coronary Artery Disease

Abstract

Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, creating a continuous need for reliable tools that can accurately identify patients at increased cardiovascular risk. Although traditional clinical risk scores are widely used, they may be insufficient for detecting subclinical atherosclerosis or predicting future coronary events in some patients. Cardiac computed tomography has become an important non-invasive imaging modality for CAD evaluation, particularly through coronary computed tomography angiography (CCTA) and coronary artery calcium scoring (CACS). CCTA allows detailed anatomical assessment of coronary stenosis, plaque burden, plaque composition, and high-risk plaque features, while CACS provides a quantitative measure of calcified atherosclerotic burden and helps reclassify patients according to their actual cardiovascular risk. In addition, standardized systems such as CAD-RADS improve communication between radiologists and clinicians and guide appropriate management decisions. Recent advances, including functional CT assessment, perivascular fat attenuation index, radiomics, spectral CT, and machine learning, have further expanded the role of CT cardiac imaging in individualized risk stratification, early preventive intervention, and optimization of treatment strategies in patients with suspected or established CAD.