Design: Multicentre randomised controlled trial
Population: 3170 emergency department patients with MI ruled out and troponin >5 ng/L, UK
Primary outcome: Myocardial infarction or cardiac death
Effect: 7.1% vs 7.3% at median 3 years, HR 0.95 (95% CI 0.73–1.23)

TARGET-CTCA enrolled 3170 patients at 14 UK emergency departments in whom myocardial infarction had been ruled out, but whose high-sensitivity troponin was above 5 ng/L, marking intermediate risk. They were randomised to outpatient CT coronary angiography-guided care or standard care. The primary outcome was myocardial infarction or cardiac death. It was published at the end of August 2026.

Almost all of the CT group (92%) had the scan. After a median of 3 years, the primary outcome occurred in 7.1% with CT-guided care and 7.3% with standard care (HR 0.95). Complications from CT were uncommon, at 0.4%.

This is a clear negative result from a large, well-conducted trial. Testing everyone with a low-positive troponin after MI rule-out found disease but did not prevent events. CT still has a role when symptoms suggest angina or the diagnosis is uncertain. As a reflex test for every intermediate-risk patient discharged from the emergency department, it does not pay off.

Do not order CT coronary angiography routinely after MI is ruled out
Base further testing on symptoms and clinical judgement, not troponin level alone
Start or optimise preventive therapy for patients with risk factors before discharge
Arrange follow-up for recurrent or typical symptoms

Why it matters

It removes the case for routine further imaging in patients whose troponin is low but detectable after MI rule-out.

The statistics, in plain English

HR 0.95 (95% CI 0.73–1.23) crosses 1, so no reduction in events was shown; the interval makes a large benefit unlikely. The trial reached its prespecified event count and nearly all patients received the allocated test, so this is a genuine negative, not an underpowered one.