Appropriateness criteria exist to help guide clinicians as to the indications for coronary CT angiography to evaluate for coronary artery disease or other coronary anomalies. The scoring system is 1-9 with scores of 1-3 being inappropriate indications, 4-6 uncertain indications and 7-9 appropriate indications. Note that a high pretest probability of coronary disease with symptoms warrants invasive coronary angiography and is not an indication for coronary CT angiography. The appropriate indications for coronary CT angiography that received a score of 7-9 are:

Non-acute symptoms

1. Discordant exercise ECG and imaging results (equivocal stress test)
2. Prior normal stress test with continued symptoms concerning for angina
3. ECG interpretable, able to exercise, intermediate pretest probability for coronary disease
4. ECG uninterpretable or unable to exercise with low or intermediate pretest probability for coronary disease
5. Evaluation of patency coronary artery bypass grafts

Acute symptoms

1. Normal ECG and cardiac markers with low or intermediate pretest probability for coronary disease
2. ECG uninterpretable (old left bundle branch or paced rhythm) with low or intermediate pretest probability for coronary disease
3. Non-diagnostic ECG or equivocal cardiac biomarkers with low to intermediate pretest probability

Other scenarios

1. New onset heart failure with reduced ejection fraction, no prior coronary disease and no anginal symptoms
2. Coronary evaluation prior to non-coronary cardiac surgery (i.e. valve replacement) in a patient with intermediate pretest probability for coronary disease
3. Evaluation of coronary anomalies and complex congenital heart disease