CT as gatekeeper of invasive coronary angiography in patients with suspected CAD

Cardiac CT has been accepted as a valuable diagnostic tool in today’s patient care. However, several other noninvasive, in particular, functional diagnostic tests are available on the menu for the ordering clinician and target more or less the same patient population. These tests come with a cost and financial constraints in the present economic environment will no longer allow its indiscriminate use. The gatekeeper function of a diagnostic testing strategy implies that a test is selected judiciously with the aim of preventing access to invasive yet expensive coronary angiography. On the basis of current knowledge, cardiac CT stands a good chance to claim the position of effective gatekeeper to the cathlab.