Design: Multicentre randomised controlled trial
Population: 3,170 ED patients with MI ruled out and peak hs-troponin >5 ng/L
Primary outcome: Myocardial infarction or cardiac death
Effect: 7.1% vs 7.3%; adjusted HR 0.95 (95% CI 0.73–1.23) at median 3 years

TARGET-CTCA enrolled 3,170 patients at 14 UK emergency departments in whom myocardial infarction had been ruled out but whose peak high-sensitivity troponin was above 5 ng/L — an intermediate-risk group. They were randomised to outpatient CT coronary angiography-guided care or standard care.

CT was done in 92% of the intervention group. After a median of three years, cardiac death or MI occurred in 7.1% vs 7.3% (adjusted HR 0.95, 95% CI 0.73–1.23). CT-related adverse events were rare (0.4%).

The risk in this group is real, but a blanket CT pathway did not lower it. That does not make CT useless for diagnosis in a symptomatic patient; it means sending everyone with a detectable troponin for CT after a negative rule-out is not a prevention strategy.

Do not order routine CT coronary angiography for every patient discharged after MI rule-out with detectable troponin.
Continue to use CT coronary angiography when ongoing symptoms suggest angina and the diagnosis is uncertain.
Use the admission to address risk factors: statin eligibility, blood pressure, smoking, diabetes.
A troponin above 5 ng/L still flags higher risk — arrange appropriate follow-up rather than simple discharge.
CT carried a 0.4% adverse event rate, low but not zero.

Why it matters

It challenges the reflex to image everyone with a detectable troponin after a negative rule-out.

The statistics, in plain English

An adjusted hazard ratio of 0.95 with a confidence interval of 0.73 to 1.23 crosses 1.0, so the trial found no difference. The interval is fairly wide: it is compatible with a modest benefit or a modest harm, but excludes a large benefit.