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The advent of photon-counting CT (PCCT) signifies a paradigm shift in cardiovascular imaging, as eloquently reviewed by Cademartiri et al in their recent comprehensive systematic review in our current issue.1 Cardiac CT has become a cornerstone of modern cardiology over the past decade, with robust data from multiple randomised trials supporting its use in primary prevention via coronary artery calcium scoring and in evaluating stable angina and acute chest pain. Current guidelines now endorse cardiac CT with a Class Ia recommendation.2 Despite these achievements, conventional CT technology remains constrained in scenarios involving heavy calcifications, prior stents and the growing clinical imperative for lower radiation doses and enhanced spatial resolution. Where do we go from here? The next frontier is PCCT.