Troponin in acute chest pain to risk stratify and guide effective use of computed tomography coronary angiography (TARGET-CTCA): a randomised controlled trial

Lee, K. K. et al. (2023) Troponin in acute chest pain to risk stratify and guide effective use of computed tomography coronary angiography (TARGET-CTCA): a randomised controlled trial. Trials, 24, 402. (doi: 10.1186/s13063-023-07431-9) (PMID:37312104) (PMCID:PMC10264092)

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

• Item Type: Articles
• Additional Information: TARGET-CTCA is funded by the British Heart Foundation (CS/18/1/33711).
• Keywords: High-sensitivity cardiac troponin, computed tomography coronary angiography, coronary heart disease, acute coronary syndrome.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Byrne, Dr John and Roditi, Dr Giles and Lowe, Dr David
• Authors: Lee, K. K., Lowe, D., O’Brien, R., Wereski, R., Bularga, A., Taggart, C., Lowry, M. T. H., Ferry, A. V., Williams, M. C., Roditi, G., Byrne, J., Tuck, C., Cranley, D., Thokala, P., Goodacre, S., Keerie, C., Norrie, J., Newby, D. E., Gray, A. J., and Mills, N. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Trials
• Publisher: BioMed Central
• ISSN: 1745-6215
• ISSN (Online): 1745-6215
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Trials 24: 402
• Publisher Policy: Reproduced under a Creative Commons License