Troponin in Acute Chest Pain to Risk Stratify and Guide Effective Use of Computed Tomography Coronary Angiography (TARGET-CTCA): A Randomised Controlled Trial

Authors

Kuan Ken Lee
David Lowe
Rachel O'Brien
Ryan Wereski
Anda Bularga
Caelan Taggart
Matthew T H Lowry
Amy V Ferry
Michelle C Williams
Giles Roditi
John Byrne
Chris Tuck
Denise Cranley
Praveen Thokala
Steve Goodacre
Catriona Keerie
John Norrie
David E Newby
Alasdair J Gray
Nicholas L Mills

Publication Date

6-13-2023

Journal

Trials

Abstract

BACKGROUND: The majority of patients with suspected acute coronary syndrome presenting to the emergency department will be discharged once myocardial infarction has been ruled out, although a proportion will have unrecognised coronary artery disease. In this setting, high-sensitivity cardiac troponin identifies those at increased risk of future cardiac events. In patients with intermediate cardiac troponin concentrations in whom myocardial infarction has been ruled out, this trial aims to investigate whether outpatient computed tomography coronary angiography (CTCA) reduces subsequent myocardial infarction or cardiac death.

METHODS: TARGET-CTCA is a multicentre prospective randomised open label with blinded endpoint parallel group event driven trial. After myocardial infarction and clear alternative diagnoses have been ruled out, participants with intermediate cardiac troponin concentrations (5 ng/L to 99th centile upper reference limit) will be randomised 1:1 to outpatient CTCA plus standard of care or standard of care alone. The primary endpoint is myocardial infarction or cardiac death. Secondary endpoints include clinical, patient-centred, process and cost-effectiveness. Recruitment of 2270 patients will give 90% power with a two-sided P value of 0.05 to detect a 40% relative risk reduction in the primary endpoint. Follow-up will continue until 97 primary outcome events have been accrued in the standard care arm with an estimated median follow-up of 36 months.

DISCUSSION: This randomised controlled trial will determine whether high-sensitivity cardiac troponin-guided CTCA can improve outcomes and reduce subsequent major adverse cardiac events in patients presenting to the emergency department who do not have myocardial infarction.

Keywords

High-sensitivity cardiac troponin, Computed tomography coronary angiography, Coronary heart disease, Acute coronary syndrome

Comments

Trial registration: ClinicalTrials.gov Identifier: NCT03952351. Registered on May 16, 2019

Supplementary Materials

PMID: 37312104