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NCT Number: NCT03952351

Troponin in Acute Chest Pain to Risk Stratify and Guide EffecTive Use of Computed Tomography Coronary Angiography

Most patients presenting to hospital with symptoms of a heart attack are sent home without further tests once a heart attack has been ruled out. Current strategies to assess patients with a suspected heart attack involve blood tests to measure troponin, a protein released into the bloodstream when the heart muscle is damaged.

Despite having had a heart attack ruled-out, some patients have unrecognised heart disease and are at risk of having a heart attack in the future. However, clinicians do not know what is the best approach to identify and treat these patients.

This study will use a heart scan known as computed tomography coronary angiogram (CTCA) to look for unrecognised heart disease in patients who have had a heart attack ruled out. In an earlier study, the Investigators performed this scan in patients referred to the outpatient cardiology clinic with stable chest pain and found that this improved the diagnosis of heart disease, leading to improvement in patient care that prevented future heart attacks.

Previous research from the Investigators has also found that troponin levels below those used to diagnose a heart attack may help to identify those who are at greater risk of having a heart attack in the future.

The aim of this study is to find out if patients with these low levels of troponin, where a heart attack has been ruled out, will benefit from CTCA to look for unrecognised coronary heart disease.

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This study is active but is not currently recruiting participants.

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Key information

Conditions

Coronary Artery Disease Arterial Occlusive Diseases Arteriosclerosis Cardiovascular Diseases Coronary Disease Heart Diseases Myocardial Ischemia Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

NHS Lothian, Edinburgh, United Kingdom

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Presenting to hospital with symptoms of suspected acute coronary syndrome
  • Age 18 years and over
  • Maximum high-sensitivity cardiac troponin concentration between 5ng/L and the 99th percentile

Exclusion criteria

  • Diagnosis of myocardial infarction during index presentation
  • Clear alternative diagnosis or participant requires further inpatient clinical assessment
  • Recent CTCA or invasive coronary angiogram (within 1 year)
  • Patient inability to undergo CT scanning, e.g. due to severe renal failure (estimated glomerular filtration rate <30 mL/min) or major allergy to iodinated contrast media
  • Current pregnancy or breast feeding
  • Inability to give informed consent
  • Further investigation for coronary artery disease would not be in the patient's interest, e.g. due to limited life expectancy, quality of life or functional status
  • Previous randomisation into the trial

Treatment and study plan

CT Coronary Angiography (CTCA)

Radiation

CTCA scan in accordance with British Society of Cardiovascular Imaging CT guidelines

Primary outcomes

  1. Composite of myocardial infarction or cardiac death

    Time frame: Randomisation through to study completion, median duration of 36 months

    The first event of myocardial infarction or cardiac death

Secondary outcomes

  1. Myocardial Infarction

    Time frame: Randomisation through to study completion, median duration of 36 months

    The first event of myocardial infarction (MI). MI will be defined according to the 4th Universal Definition of Myocardial Infarction

  2. Cardiac death

    Time frame: Randomisation through to study completion, median duration of 36 months

    Cardiac death will be defined as death resulting from an acute myocardial infarction, sudden cardiac death, or death due to heart failure.

  3. Cardiovascular death

    Time frame: Randomisation through to study completion, median duration of 36 months

    Cardiovascular death will be defined as death resulting from an acute myocardial infarction, sudden cardiac death, death due to heart failure, death due to stroke, death due to cardiovascular haemorrhage, and death due to other cardiovascular causes

  4. Non-cardiovascular death

    Time frame: Randomisation through to study completion, median duration of 36 months

  5. All-cause death

    Time frame: Randomisation through to study completion, median duration of 36 months

  6. Unscheduled urgent coronary revascularisation

    Time frame: Randomisation through to study completion, median duration of 36 months

    Unscheduled urgent coronary revascularisation will be identified via record linkage from central NHS registers (e.g. the Scottish Morbidity Register by the Information Services Division (ISD) Scotland) or from extracts obtained from the participating hospitals electronic patient record system.

  7. Hospital reattendance with suspected ACS

    Time frame: Randomisation through to study completion, median duration of 36 months

    Reattendance with suspected ACS will be defined as any unscheduled hospital attendance where cardiac troponin testing is performed for suspected ACS following randomisation

  8. Proportion of patients with major bleeding (BARC 3-5)

    Time frame: Randomisation through to study completion, median duration of 36 months

    Bleeding will be defined according to the Bleeding Academic Research Consortium (BARC) definition of bleeding. We will use pre-defined codes from International Classification of Diseases (ICD-10) and Office of Population Censuses and Surveys (OPCS) to classify each bleeding event as per the BARC definition.

  9. Symptomatic status as assessed by the short form Seattle Angina Questionnaire (SAQ-7)

    Time frame: 3, 12 and 24 months

  10. Quality of life as assessed by the EQ-5D-5L

    Time frame: 3, 12 and 24 months

Other outcomes

  1. Proportion of patients with allergy/anaphylaxis/acute kidney injury following study CTCA scan

    Time frame: 2 weeks

  2. Proportion of patients undergoing non-study CTCA or invasive coronary angiography (ICA)

    Time frame: 90 days

  3. Proportion of patients with clinically significant abnormal non-cardiac findings on study CTCA scan

    Time frame: 2 weeks

  4. Dose length product from study CTCA scan

    Time frame: 2 weeks

  5. Proportion of patients undergoing non-invasive stress test (cost-effectiveness)

    Time frame: 90 days

  6. Proportion of patients prescribed therapies for coronary artery disease (cost-effectiveness)

    Time frame: Randomisation through to study completion, median duration of 36 months

  7. Proportion of patients undergoing planned revascularisation (cost-effectiveness)

    Time frame: Randomisation through to study completion, median duration of 36 months

  8. Incremental cost per quality-adjusted life year (QALY) gained (cost-effectiveness)

    Time frame: Randomisation through to study completion, median duration of 36 months

Sponsors and collaborators

Lead sponsor

University of Edinburgh

Other

Collaborators

  • British Heart Foundation
  • NHS Greater Glasgow and Clyde
  • NHS Lothian
  • University of Sheffield

Registry information

Acronym: TARGET-CTCA

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 16, 2019
Registry last updated
Apr 21, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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