Rationale and Design of the “PRECISION-CT” Study—A Prospective Evaluation of Coronary CTA Integration for Strategy Improvement and Optimization of PCI in Chronic Coronary Syndrome

<b>Background:</b> Coronary computed tomography angiography (CCTA) is a well-established key diagnostic modality for ruling out obstructive coronary artery disease (CAD) in patients with suspected chronic coronary syndromes (CCSs) and low to intermediate pre-test probability. The widespread availability of preprocedural CCTA data in CCS patients undergoing percutaneous coronary intervention (PCI), however, creates a new opportunity for image-guided procedural planning. <b>Objective:</b> The PRECISION-CT study (Prospective Evaluation of Coronary CTA Integration for Strategy Improvement and Optimization of Non-Emergent PCI) aims to evaluate the impact of CCTA-guided PCI on patient safety and clinical outcomes. <b>Methods:</b> PRECISION-CT is a prospective, two-center, randomized controlled trial, enrolling patients with CCS scheduled for elective PCI due to obstructive CAD by CCTA. Patients are randomized 1:1 to either CCTA-guided PCI or standard angiography-guided PCI. In patients randomized to CCTA-guided PCI, advanced post-processing of CCTA datasets provides specific procedural planning recommendations based on the detailed assessment of coronary artery takeoff, lesion location and plaque characteristics. In addition, real-time integration of the advanced CCTA post-processing is available in the catheterization laboratory during the PCI procedure. Patients randomized to angiography-guided PCI are treated according to routine clinical practice. <b>Results</b>: The primary endpoint is a composite procedural safety and efficacy score including: (i) need for intravascular imaging, (ii) procedural complications, (iii) post-procedural high-sensitivity troponin T elevation, (iv) contrast media, (v) radiation exposure, and (vi) length of hospital stay. Secondary endpoints include major cardiac adverse events such as cardiac death, non-fatal myocardial infarction, target-lesion reintervention and probable or definitive stent thrombosis during 1 year of follow-up. <b>Conclusions:</b> The PRECISION-CT study will provide pragmatic evidence on the ability of CT-guided PCI in patients with CCS to optimize procedural outcomes. These findings may help inform the broader adoption of image-guided precision revascularization strategies in interventional cardiology.