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

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.

Ninety-two per cent of the CT group had the scan. After a median 3 years, MI or cardiac death occurred in 7.1% versus 7.3% (adjusted HR 0.95, 95% CI 0.73–1.23).

The idea was sensible: many of these patients have undiagnosed coronary disease and might benefit from preventive therapy started after a scan. But in practice, routine imaging did not change hard outcomes. The result does not say CT angiography is useless in chest pain — it says it should not be ordered on everyone discharged after MI is excluded.

Do not order CT coronary angiography routinely for every patient sent home after MI has been ruled out.
Use it where there is a genuine diagnostic question — ongoing symptoms, a convincing angina history.
Start guideline preventive therapy on the basis of risk factors, which does not need a scan.
Low-level troponin above 5 ng/L marks higher risk; make sure risk factors are treated at discharge.

Why it matters

It removes a plausible reason for scanning large numbers of low-to-intermediate-risk chest pain patients.

The statistics, in plain English

An HR of 0.95 with a confidence interval of 0.73–1.23 is compatible with a 27% benefit or a 23% harm — in other words, the trial found no reliable difference either way.