Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Many patients with suspected acute coronary syndrome in whom myocardial infarction has been ruled out in the emergency department remain at risk for cardiovascular events. Whether further investigation reduces this risk is unknown. METHODS: In a multicenter, randomized, controlled trial, patients who presented to an emergency department in 14 hospitals across the United Kingdom were enrolled if myocardial infarction had been ruled out and high-sensitivity cardiac troponin testing indicated an intermediate risk of a cardiovascular event (maximum high-sensitivity cardiac troponin I or T concentration, >5 ng per liter). Participants were randomly assigned in a 1:1 ratio to receive either outpatient computed tomographic (CT) coronary angiography-guided care or standard care. The primary outcome was a composite of myocardial infarction or death from a cardiac cause. RESULTS: From September 18, 2019, to May 11, 2023, a total of 3170 participants (median age, 61 years; female sex, 30.2%) were assigned to undergo CT coronary angiography (1587 participants) or receive standard care (1583 participants). At 90 days after randomization, CT coronary angiography had been performed in 1462 participants (92.1%) in the CT coronary angiography group and in 35 participants (2.2%) in the standard-care group. Overall, 7 participants (0.4%) had a CT coronary angiography-related adverse event. After a median of 3.0 years, at which point the number of primary-outcome events in the standard-care group exceeded the prespecified minimum of 97, a primary-outcome event had occurred in 112 participants (7.1%) in the CT coronary angiography group and in 116 (7.3%) in the standard-care group (adjusted hazard ratio, 0.95; 95% confidence interval, 0.73 to 1.23; P = 0.71). CONCLUSIONS: In patients with suspected acute coronary syndrome in whom myocardial infarction had been ruled out, routine CT coronary angiography-guided management did not result in a lower incidence of subsequent myocardial infarction or death from a cardiac cause than standard care. (Funded by the British Heart Foundation; TARGET-CTCA ClinicalTrials.gov number, NCT03952351.).
Source: New England Journal of Medicine
Authors: Kuan Ken Lee, Ryan Wereski, David Lowe, Rachel O’Brien, Amy V. Ferry, Anda Bularga, Matthew T.H. Lowry, Caelan Taggart, Giles Roditi, Nick Curzen, Sarojini David, Dirk Felmeden, Randeep Hunjan, Attila Kardos, Liza Keating, Dennis Sandeman, Jason E. Smith, Carl Roobottom, Chris Tuck, Denise Cranley, Praveen Thokala, Steve Goodacre, Titouan Kennel, Catriona Keerie, John Norrie, Michelle C. Williams, David E. Newby, Alasdair J. Gray, Nicholas L. Mills
Institutions: British Heart Foundation, University of Edinburgh, Queen Elizabeth University Hospital, Edinburgh Royal Infirmary, University of Glasgow, University Hospital Southampton NHS Foundation Trust, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Milton Keynes Hospital, Milton Keynes Hospital NHS Foundation Trust, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, NHS Fife, Victoria Hospital, Derriford Hospital, University Hospitals Plymouth NHS Trust, University of York, University of Sheffield, Queen's University Belfast
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: British Heart Foundation
OpenAlex ID: W7204666377