Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain

NEJM · ESC 2026 · RCT. After MI rule-out, routine CT angiography didn't prevent MI or cardiac death. TARGET-CTCA: Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain Patients whose acute chest pain proves not to be myocardial infarction still carry meaningful longer-term coronary risk. Does outpatient CT coronary angiography-guided care reduce the composite of myocardial infarction or death from a cardiac cause in patients with suspected acute coronary syndrome in whom… 3170 participants, Multicenter randomized controlled trial…. MI or death from a cardiac cause: CTCA-guided 7.1% vs Standard care 7.3%. HR 0.95 (95% CI 0.73–1.23), P=0.71. Read with care. CTCA-related adverse events 7/1,587 (0.4%) in the CTCA group. Applies only to intermediate-risk patients (peak hs-cTn >5 ng/L) after MI has been ruled out, and was conducted… Follow-up was event-driven, ending once standard-care primary-outcome events exceeded the prespecified minimum of 97. Where experts stand: Experts read TARGET-CTCA as a clear null result, confirming that routine CT coronary angiography after a heart attack has been ruled out does not improve outcomes and should not become standard… Abdulla A. Damluji (Interventional Cardiology): Anything that is "routine" usually does not work Reza Ghanavati (Polytechnic University of Turin): Implementing CTCA to guide management in these patients is not warranted Synapse summaries of their public posts Still open: Why does improved diagnostic efficiency from CTCA not translate into better patient outcomes? Read the evidence. See where experts stand. synapsesocial.com/papers/6a8fbb6317152b56e6b64821