Troponin in acute chest pain to risk stratify and guide effective use of computed tomography coronary angiography (TARGET-CTCA): a randomised controlled trial
Kuan Ken Lee,
David Lowe,
Rachel O’Brien,
Ryan Wereski,
Anda Bularga,
Caelan Taggart,
Matthew T. H. Lowry,
Amy V. Ferry,
Michelle C. Williams,
Giles Roditi,
John Byrne,
Chris Tuck,
Denise Cranley,
Praveen Thokala,
Steve Goodacre,
Catriona Keerie,
John Norrie,
David E. Newby,
Alasdair J. Gray,
Nicholas L. Mills
Affiliations
Kuan Ken Lee
BHF Centre for Cardiovascular Science, University of Edinburgh
David Lowe
Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde
Rachel O’Brien
Department of Emergency Medicine, Emergency Medicine Research Group, Royal Infirmary of Edinburgh
Ryan Wereski
BHF Centre for Cardiovascular Science, University of Edinburgh
Anda Bularga
BHF Centre for Cardiovascular Science, University of Edinburgh
Caelan Taggart
BHF Centre for Cardiovascular Science, University of Edinburgh
Matthew T. H. Lowry
BHF Centre for Cardiovascular Science, University of Edinburgh
Amy V. Ferry
BHF Centre for Cardiovascular Science, University of Edinburgh
Michelle C. Williams
BHF Centre for Cardiovascular Science, University of Edinburgh
Giles Roditi
Institute of Cardiovascular and Medical Sciences, Glasgow University
John Byrne
Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde
Chris Tuck
BHF Centre for Cardiovascular Science, University of Edinburgh
Denise Cranley
Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh
Praveen Thokala
School of Health and Related Research (ScHARR), University of Sheffield
Steve Goodacre
School of Health and Related Research (ScHARR), University of Sheffield
Catriona Keerie
Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh
John Norrie
Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh
David E. Newby
BHF Centre for Cardiovascular Science, University of Edinburgh
Alasdair J. Gray
Department of Emergency Medicine, Emergency Medicine Research Group, Royal Infirmary of Edinburgh
Nicholas L. Mills
BHF Centre for Cardiovascular Science, University of Edinburgh
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.
