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News
Skipping the CT scan may be fine after all. The TARGET-CTCA trial found that coronary CT angiography (CCTA) did not reduce MI or cardiac death compared to standard care in intermediate-risk chest pain patients whose heart attacks had already been ruled out. After 3 years of follow-up, outcomes were nearly identical between the two groups, challenging current US guidelines that recommend CCTA for this population.
Think twice before ordering that CT. The TARGET-CTCA trial, presented at the European Society of Cardiology Congress 2026 and simultaneously published in the New England Journal of Medicine, found that coronary CT angiography (CCTA) did not meaningfully reduce MI or cardiac death in intermediate-risk chest pain patients who had already had a heart attack ruled out. After a median 3-year follow-up, outcomes were nearly identical between the CCTA and standard-care groups.
Lead investigator Dr. Nicholas Mills (University of Edinburgh) noted that while elevated troponin signals future risk, that risk isn't necessarily driven by coronary artery disease — meaning imaging the coronaries may not be the right next step. The trial enrolled 3,170 patients across 14 UK hospitals, and no subgroup — including those with higher troponin levels or HEART scores — showed a clear benefit from CCTA.
Key Takeaways:
Why it matters: Current US guidelines give CCTA a Class I recommendation for intermediate-risk chest pain patients in the ED. These findings suggest that once MI is confidently ruled out, routine coronary imaging may not be warranted — potentially reshaping how emergency chest pain workups are conducted.
