The Real-World Spectrum of Coronary CT Angiography Findings: Patterns and Vessel Distribution

Objective: To describe the spectrum of documented CCTA findings, the extent of coronary involvement, and the distribution of involved coronary territories in a tertiary-care clinical dataset. Study Design: Retrospective observational cross-sectional study.Place and Duration of Study: This study was conducted at the Tertiary Cardiac Center, Saudi Arabia, from 6th May 2026 to 30th July 2026. Methodology: This retrospective cross-sectional study was conducted in 2026 using historical clinical/procedural records from patients attending the cardiac clinic or catheterization service between 1 September and 31 December 2025. The study was approved by the Research Ethics Committee of King Faisal University in May 2026. After excluding records without a usable coronary CCTA entry and four non-coronary vascular CT entries, 172 eligible CCTA-related records remained. To avoid repeated counting, one index record per patient was used, yielding 153 patients for analysis. Results: Among 153 index CCTA records, 113 (73.9%) documented severe stenosis, total occlusion, or explicit three-vessel disease; 29 (19.0%) documented moderate disease, 3 (2.0%) mild disease, and 3 (2.0%) normal coronary arteries. Five records (3.3%) contained other coronary findings that could not be placed in these stenosis categories. A single or isolated named coronary territory was documented in 104 patients (68.0%), while 40 (26.1%) had multi-vessel involvement. LAD territory involvement was most frequent (102, 66.7%), followed by RCA (52, 34.0%) and LCX (35, 22.9%); multiple territories could be present in one patient. Conclusion: The analyzed tertiary-care records showed a predominance of advanced coronary findings and frequent LAD involvement. These results describe a selected clinical population and should not be interpreted as population prevalence. Standardized prospective CCTA reporting would improve future analyses of disease pattern and distribution.