Coronary Artery DiseaseTARGET-CTCANCT03952351
Troponin in Acute Chest Pain to Risk Stratify and Guide EffecTive Use of Computed Tomography Coronary Angiography
A study testing CT Coronary Angiography (CTCA) in people with Coronary Artery Disease, run by University of Edinburgh at 9 sites in United Kingdom.
Trial summary
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… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Coronary Artery Disease
- What is being tested?
- CT Coronary Angiography (CTCA)
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 3,170 participants
- Where
- 9 sitesUnited Kingdom
- Study dates
- 31 Jan 2026to 28 Feb 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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
Who cannot join
- 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
Trial locations and contacts
9 sites in 1 country.
9 sites in 1 country
United Kingdom9 sites
NHS Lothian
Edinburgh
NHS Greater Glasgow and Clyde
Glasgow
Lewisham & Greenwich NHS Trust
London
Milton Keynes University NHS Hospital
Milton Keynes
University Hospitals Plymouth NHS Trust
Plymouth
Royal Berkshire NHS Foundation Trust
Reading
University Hospital Southampton NHS Trust
Southampton
North Tees NHS Hospital Foundation
Stockton
Torbay & South Devon NHS Foundation Trust
Torquay
About this study
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.
Read more
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.
- Conditions
- Coronary Artery Disease
- Being tested
- CT Coronary Angiography (CTCA)
- Medical subject headings
- Coronary Artery Disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CT Coronary Angiography (CTCA)Radiation
CTCA scan in accordance with British Society of Cardiovascular Imaging CT guidelines
| Study group | Role | What they receive |
|---|---|---|
| CTCA with standard care | Experimental | Patients will be referred for CT Coronary Angiography, ideally within 2 weeks of randomisation Receives: Radiation: CT Coronary Angiography (CTCA) |
| Standard care | No intervention | Not described |
What is being measured
The primary outcome is the main question the study is designed to answer.
Composite of myocardial infarction or cardiac death
The first event of myocardial infarction or cardiac death
Measured: Randomisation through to study completion, median duration of 36 months
Secondary outcomes (10)
Myocardial Infarction
The first event of myocardial infarction (MI). MI will be defined according to the 4th Universal Definition of Myocardial Infarction
Measured: Randomisation through to study completion, median duration of 36 months
Cardiac death
Cardiac death will be defined as death resulting from an acute myocardial infarction, sudden cardiac death, or death due to heart failure.
Measured: Randomisation through to study completion, median duration of 36 months
Cardiovascular death
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
Measured: Randomisation through to study completion, median duration of 36 months
Non-cardiovascular death
Measured: Randomisation through to study completion, median duration of 36 months
All-cause death
Measured: Randomisation through to study completion, median duration of 36 months
Unscheduled urgent coronary revascularisation
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.
Measured: Randomisation through to study completion, median duration of 36 months
Hospital reattendance with suspected ACS
Reattendance with suspected ACS will be defined as any unscheduled hospital attendance where cardiac troponin testing is performed for suspected ACS following randomisation
Measured: Randomisation through to study completion, median duration of 36 months
Proportion of patients with major bleeding (BARC 3-5)
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.
Measured: Randomisation through to study completion, median duration of 36 months
Symptomatic status as assessed by the short form Seattle Angina Questionnaire (SAQ-7)
Measured: 3, 12 and 24 months
Quality of life as assessed by the EQ-5D-5L
Measured: 3, 12 and 24 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 May 2019
- Study start31 Jan 2026
- Primary completion31 Mar 2026
- Study completion28 Feb 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Coronary Artery DiseaseStudies of the same condition, open and under way.
- More trials run by University of EdinburghThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 3,170 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Edinburgh
- Sponsor type
- University, hospital or other
- Collaborators
- British Heart Foundation, University of Sheffield, NHS Lothian, NHS Greater Glasgow and Clyde
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03952351
- Sponsor's protocol ID
- AC18106
- Acronym
- TARGET-CTCA
- Status last verified
- Oct 2026
- First submitted
- 14 May 2019
- Last updated
- 26 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Following publication of the primary paper, a deidentified individual participant data set will be will be made available for data sharing purposes, subject to necessary governance approvals. Access to the deidentified dataset will be under a controlled access model.
Publications
Lee KK, Wereski R, Lowe D, O'Brien R, Ferry AV, Bularga A, Lowry MTH, Taggart C, Roditi G, Curzen N, David S, Felmeden D, Hunjan R, Kardos A, Keating L, Sandeman D, Smith JE, Roobottom C, Tuck C, Cranley D, Thokala P, Goodacre S, Kennel T, Keerie C, Norrie J, Williams MC, Newby DE, Gray AJ, Mills NL; TARGET-CTCA Investigators. Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain. N Engl J Med. 2026 Aug 29. doi: 10.1056/NEJMoa2608903. Online ahead of print.
PubMed 42670980Lee KK, Lowe D, O'Brien R, Wereski R, Bularga A, Taggart C, Lowry MTH, Ferry AV, Williams MC, Roditi G, Byrne J, Tuck C, Cranley D, Thokala P, Goodacre S, Keerie C, Norrie J, Newby DE, Gray AJ, Mills NL. Troponin in acute chest pain to risk stratify and guide effective use of computed tomography coronary angiography (TARGET-CTCA): a randomised controlled trial. Trials. 2023 Jun 13;24(1):402. doi: 10.1186/s13063-023-07431-9.
PubMed 37312104
Study at a glance
From the registry record, last updated by the sponsor on 26 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Troponin in Acute Chest Pain to Risk Stratify and Guide EffecTive Use of Computed Tomography Coronary Angiography
- ClinicalTrials.gov ID
- NCT03952351
- Acronym / sponsor ID
- TARGET-CTCA / AC18106
- Conditions
- Coronary Artery Disease
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 3,170 participants (actual)
- Lead sponsor
- University of EdinburghUniversity, hospital or other
- Collaborators
- British Heart Foundation, University of Sheffield, NHS Lothian, NHS Greater Glasgow and Clyde
- Study start
- 31 Jan 2026 (actual)
- Primary completion
- 31 Mar 2026 (actual)
- Study completion
- 28 Feb 2027 (estimated)
- First posted
- 16 May 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| CTCA with standard care | Experimental | Radiation: CT Coronary Angiography (CTCA)Patients will be referred for CT Coronary Angiography, ideally within 2 weeks of randomisation |
| Standard care | No intervention | – |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- 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
Key exclusion criteria (8 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CT Coronary Angiography (CTCA)CTCA scan in accordance with British Society of Cardiovascular Imaging CT guidelines | Radiation | CTCA with standard care |
Primary outcome
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
10 secondary outcomes
Myocardial Infarction
Time frame: Randomisation through to study completion, median duration of 36 months
Cardiac death
Time frame: Randomisation through to study completion, median duration of 36 months
Cardiovascular death
Time frame: Randomisation through to study completion, median duration of 36 months
Non-cardiovascular death
Time frame: Randomisation through to study completion, median duration of 36 months
All-cause death
Time frame: Randomisation through to study completion, median duration of 36 months
Unscheduled urgent coronary revascularisation
Time frame: Randomisation through to study completion, median duration of 36 months
Hospital reattendance with suspected ACS
Time frame: Randomisation through to study completion, median duration of 36 months
Proportion of patients with major bleeding (BARC 3-5)
Time frame: Randomisation through to study completion, median duration of 36 months
Symptomatic status as assessed by the short form Seattle Angina Questionnaire (SAQ-7)
Time frame: 3, 12 and 24 months
Quality of life as assessed by the EQ-5D-5L
Time frame: 3, 12 and 24 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Oct 2026.
- Derived from this study: PubMed 42670980Lee KK, Wereski R, Lowe D, O'Brien R, Ferry AV, Bularga A, Lowry MTH, Taggart C, Roditi G, Curzen N, David S, Felmeden D, Hunjan R, Kardos A, Keating L, Sandeman D, Smith JE, Roobottom C, Tuck C, Cranley D, Thokala P, Goodacre S, Kennel T, Keerie C, Norrie J, Williams MC, Newby DE, Gray AJ, Mills NL; TARGET-CTCA Investigators. Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain. N Engl J Med. 2026 Aug 29. doi: 10.1056/NEJMoa2608903. Online ahead of print.
- Derived from this study: PubMed 37312104Lee KK, Lowe D, O'Brien R, Wereski R, Bularga A, Taggart C, Lowry MTH, Ferry AV, Williams MC, Roditi G, Byrne J, Tuck C, Cranley D, Thokala P, Goodacre S, Keerie C, Norrie J, Newby DE, Gray AJ, Mills NL. Troponin in acute chest pain to risk stratify and guide effective use of computed tomography coronary angiography (TARGET-CTCA): a randomised controlled trial. Trials. 2023 Jun 13;24(1):402. doi: 10.1186/s13063-023-07431-9.
- Individual participant dataSharing planned: Yes. Following publication of the primary paper, a deidentified individual participant data set will be will be made available for data sharing purposes, subject to necessary governance approvals. Access to the deidentified dataset will be under a controlled access model.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
9 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing CT Coronary Angiography (CTCA) in people with Coronary Artery Disease, run by University of Edinburgh at 9 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 26 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 9 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Composite of myocardial infarction or cardiac death (time frame: Randomisation through to study completion, median duration of 36 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03952351, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Oct 2026.