Coronary computed tomography angiography (CCTA) has become a robust non-invasive method in recent years for evaluating coronary atherosclerosis [1]. High quality CCTA (64 slice and higher) is currently probably the most sensitive non-invasive modality for diagnosing obstructive and non-obstructive coronary artery disease (CAD), with high negative predictive value [1, 2]. This is not surprising considering that CCTA examines coronary anatomy (or minimal luminal diameter), while other non-invasive methods invoking physiologic stress (such as myocardial perfusion imaging or stress echocardiography) evaluate the physiologic consequences of coronary arterial narrowing, i.e. myocardial ischemia. Regarding prognosis, however, the degree of inducible myocardial ischemia or the presence of extensive myocardial fibrosis and reduced left ventricular function as assessed by physiologic testing are indeed established powerful predictors of adverse cardiac events [3–7]. For this reason, physiologic assessment of myocardial ischemia and left ventricular contractile function have become the most commonly used methods for risk stratification in patients with known or suspected CAD. The prognostic value of conventional coronary angiography, which clearly delineates the severity and extent of obstructive CAD, is well established. High risk coronary anatomy (triple vessel CAD, narrowing of the left main coronary artery) is clearly associated with poorer outcome [8–10], while normal coronary anatomy is associated with an excellent prognosis [11]. Thus, the anatomy-based approach is a well established method for risk stratification of patients, especially those who are symptomatic. Nonetheless, despite many reports demonstrating the prognostic value of coronary calcifications found on nonenhanced scans [12], until very recently the prognostic value of (contrast enhanced) CCTA was unclear. The introduction of 64-slice CCTA during 2004 allowed better assessment of coronary atherosclerosis with more reliable results [13]. In recent years, several papers reported mid-term outcome of patients undergoing 64-slice CCTA. Since most of these outcome studies were a single center experience and usually based on a scanner from a single vendor, it was indeed logical to combine the results of those studies to better appreciate the prognostic usefulness of CCTA. In this issue of the journal, Abdulla and colleagues [14] report a meta-analysis of 10 relatively large studies (range 100–2,076 patients/study) evaluating the prognostic value of 64-slice CCTA. The combined end point of cardiac death, myocardial infarction and coronary revascularization (MACE) was evaluated in Editorial comment to the article by Abdullah et al. doi:10.1007/s10554-010-9652-x.