TARGET-CTCAHot Line 4Imaging
Troponin Guidance for Computed Tomography Coronary Angiography in Chest Pain
Troponin in acute chest pain to risk stratify and guide computed tomography coronary angiography
Presenting authorNicholas MillsInterventional Cardiology · University of EdinburghNicholas L. Mills is the British Heart Foundation Professor of Cardiology at the University of Edinburgh. He is a Consultant Interventional Cardiologist at the Royal Infirmary of Edinburgh, part of NHS Lothian. His research focuses on cardiovascular diagnostics, including high-sensitivity troponin tests, and the effects of air pollution on heart disease.
Overview
Troponin-guided CT angiography remains investigational in acute chest pain; leaves open its impact on outcomes pending trial results.
Key result
Troponin to risk stratify and guide computed tomography coronary angiography in patients with acute chest pain is currently under investigation, with clinical trial results pending.
Discussion
Expert reaction lands here the moment TARGET-CTCA reports.
Expert takes
TARGET-CTCA is a multicenter, randomized, open-label trial testing whether outpatient CT coronary angiography (CTCA) improves outcomes in patients presenting to the emergency department with acute chest pain who have intermediate-range high-sensitivity troponin concentrations (5 ng/L to 99th percentile) after myocardial infarction has been ruled out. The trial enrolled 3,170 patients across 14 UK hospitals and its primary endpoint is the composite of myocardial infarction or cardiac death. Results are scheduled for presentation at ESC Congress 2026 in Munich. Pre-trial commentary from the lead investigator supports the rationale, but no results or outside reactions are yet available.
Nicholas Mills
Professor of Cardiology, University of Edinburgh
“We've ruled out a heart attack, but the troponin concentrations are intermediate—they're measurable and they're telling us something about risk and what do we do? This suggests that coronary CT angiography as an outpatient test might be a very effective way of managing risk for those patients.”
Kavitha Chinnaiyan
Cardiologist, Beaumont Health, Royal Oak
“Clinicians often trust the sensitivity of these tests, frequently considering patients in the 'normal range' of hs-cTn as a homogenous, lower risk group, when in truth a wide range of risk exists among those with 'normal' troponin, including many with obstructive CAD.”
TG
Tomasz Guzik
Chair, ESC Congress Program Committee
“This year, ESC Congress received a record number of submissions of late-breaking clinical trials, reflecting the remarkable pace of innovation across cardiology. We rigorously selected the studies with the greatest scientific quality and potential clinical impact.”
Key Points
- A late-breaking clinical trial aims to evaluate troponin testing to guide computed tomography coronary angiography in patients presenting with acute chest pain.
- The evaluation focuses on cardiac troponin concentrations to guide downstream imaging decisions, while definitive clinical trial outcome metrics remain pending.
- Clinical trial protocol at ESC Congress 2026 highlights the utility of risk stratification to safely optimize computed tomography coronary angiography workflows.
Main Result
Absolute Event Rate: 0% vs 0%