TARGET-CTCA
Troponin in acute chest pain to risk stratify and guide computed tomography coronary angiography
Presented by Nicholas Mills
Subspecialty: Imaging
Published in NEJM
Key Result
Routine CTCA after myocardial infarction was ruled out did not reduce subsequent MI or cardiovascular death versus standard care over three years (7.1% vs 7.3%) among 3,170 patients with acute chest pain.
What did this trial find?
TARGET-CTCA randomised 3,170 patients with acute chest pain (MI ruled out, intermediate troponin) to early outpatient CT coronary angiography plus standard care versus standard care alone across 14 UK emergency departments. Over three years, routine CTCA did not reduce subsequent MI or cardiovascular death (7.1% vs 7.3%), providing strong evidence against routine imaging after MI rule-out. The trial was presented at ESC Congress 2026 and simultaneously published in NEJM. Coverage is largely straightforward, with the lead investigator and a BHF clinical director commenting on the implications for reducing unnecessary testing.
Abstract
TARGET-CTCA randomised 3,170 patients with acute chest pain in whom myocardial infarction had been excluded in the emergency department to early outpatient CT coronary angiography plus standard care or standard care alone. Over three years the primary composite of myocardial infarction or cardiovascular death occurred in 7.1% with CTCA-guided management and 7.3% with standard care. The trial, presented by Nicholas Mills and simultaneously published in the New England Journal of Medicine (10.1056/nejmoa2608903), does not support routine CTCA after a heart attack has been ruled out. Source: ESC Congress 2026 / British Heart Foundation coverage, 29 August 2026.