The intravascular ultrasound qualities of coronary computed tomographic angiography provide the rationale for a new approach to the selection of patients for percutaneous coronary intervention and to guide the performance of the procedure. Minimum luminal diameter and minimum luminal area derived from computed tomographic angiography are readily measured and are used to triage patients to medical therapy or angiographic evaluation, with subsequent decisions based on the severity of disease and intravascular ultrasound findings. Technical decisions related to percutaneous coronary intervention are guided by lesion length and plaque characteristics. In conclusion, computed tomographic angiography has the requisite intravascular ultrasound characteristics to greatly impact percutaneous coronary intervention.