It seems to me that today there are no studies regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Perhaps, CT coronary angiography may be used before performing invasive coronary angiography in patients with an intermediate pretest probability of CHD... I think there are illusory benefits while absolutely real ethical and socio-economic problems...

On the contrary, MR angiography has some important advantages because it does not involve radiation exposure or the intravenous injection of an iodinated contrast agent.

Article CT coronary angiography vs. invasive coronary angiography in CHD

Conference Paper Non-invasive coronary CT angiography-based Heart Team assess...

Thanks Tatiyana for your answar. Definitely there is no guideline or recommendations in this regard. But from my clinical experience I think in the following clinical situation CT coronary angiography will be better than invasive coronary angiography....                             .1coronary AV fistula. 2.Abnormal origin and course of coronary artery 3.Aortic dissection with coronary artery involvement. 4.sponteneous coronary artery dissection 4.coronary artery aneurysm 5 extrinsic compression of coronary artery like compression of LMCA from dilated pulmonary artery. 6.Occluded venous graft from osteum in post CABG patient. .7Difficult vascular access in extensive peripheral vascular disease CT coronary angiography may be better option.. .thanks 

First of all CT coronary angiography will be better when invasive coronary angiography contraindications. For example: The patient has an allergy to an X-ray contrast substance; The patient has severe renal or heart failure; Severe anemia, a clotting disorder in the patient; The patient has an acute infectious diseas; The patient has endocarditi; The patient has arterial hypertension ander control by Mx.

And the next but not the last - patients refused.

Besides Dr. Majumder and Kozhukhov indications, coronary tomography should be used to discard critical coronary artery and/or graft involement in patients with  difuse coronary artery disease that have been treated with angioplasty or CABG and are having atypical angina symptoms. In these situations myocardial perfusion tests may be misleading for clinical decision making.

Conclusion. Compare traditional coronary angiograms, CT angiograms don't use a catheter threaded through your blood vessels to your heart. CT angiograms are noninvasive and don't require any recovery time. Both coronary angiograms expose you to radiation. If pts have known CAD, a traditional coronary angiogram may be a better option, because you can also receive treatment for your CAD during this procedure.

1. When risk of coronary artery disease is low, but coronary anatomy should be known (f.e. valvular disease in young patient)

2. When coronary artery is closed and not visible in angi

3. When there is no vascular access to perform angiography

In all other conditions - when you potentially plan to treat coronary artery disease better is to perform angio (save contrast and radiation) - just after angio PTCA is possible in most cases when indicated. After CT, when diagnosed coronary artery disease, in most cases must also perform angio before treatment (double contrast and radiation exposure). Most published comparisons doesn't show fact that usually angiography perforemd by experience operator need less radiation (

In continue our conversation about CT coronary angiography please read article comment Targeted coronary post-mortem CT angiography, straight to the heart. As for me it is new direction to use CTA.