Troponin in Acute Chest Pain to Risk Stratify and Guide EffecTive Use of Computed Tomography Coronary Angiography (TARGET-CTCA)

doi:10.1056/nejmoa2608903

TARGET-CTCA

Patient / Population Intervention / Exposure Comparison Outcome

In 3,170 patients with suspected ACS, infarction ruled out and an intermediate troponin, outpatient CT coronary angiography did not reduce myocardial infarction or cardiac death compared with standard care.

N

3,170patients

Design

Multicentre (14 UK hospitals), prospective, randomised, open-label, blinded-endpoint (PROBE), parallel-group, event-driven superiority trial; 1:1 allocation to outpatient CTCA plus standard care or standard care alone; minimum 24 months and median 36 months follow-up; powered on 97 primary-outcome events in the standard-care arm

Endpoint

Composite of myocardial infarction or cardiac death (time to first event)

Relevance

2Important — one of several pillars.

ResultMyocardial infarction or cardiac death after a median 3.0 years in 7.1% vs 7.3% (adjusted HR 0.95, 95% CI 0.73-1.23; P = 0.71). CT coronary angiography was performed within 90 days in 92.1% of the CT group and 2.2% of the standard-care group; 0.4% had a CT-related adverse event.

Lee KK, Wereski R, Lowe DJ, et al. N Engl J Med. 2026; published online 29 August. 10.1056/nejmoa2608903

Discussion & critique

Ruling out infarction leaves a patient with an intermediate troponin and no answer, and the intuition is to look at the arteries. Over three years that look changed nothing: 7.1% against 7.3%, with a separation of 90 percentage points in who actually got scanned, so this is a real test of the strategy rather than a diluted one. The interval runs to 1.23, which leaves room for a small benefit but not for the one that would justify scanning everyone; what the trial does not address is whether a targeted subgroup — or a different response to what the scan finds — would fare differently.