Troponin in Acute chest pain to Risk stratify and Guide EffecTive use of Computed Tomography Coronary Angiography
Patients with acute chest pain account for 6% of all presentations to the Emergency Department and 27% of unplanned hospital admissions, with their assessment a major burden on health care resources. In 2016-2017, there were 363,174 unplanned hospital admissions with chest pain in England alone. Current assessment strategies focus on ruling in or ruling out acute myocardial infarction through bedside clinical assessment, electrocardiography and serial cardiac troponin testing. Once myocardial infarction is ruled out, most patients are discharged from hospital without further investigation or treatment even though a significant proportion may have underlying coronary artery disease. Our research suggests that the use of next generation high-sensitivity cardiac troponin assays, which permit quantification of troponin concentrations at very low concentrations, have major potential to improve the risk stratification of patients with acute chest pain, and identify those who may benefit from further investigation and treatment.
TARGET-CTCA is a prospective, randomised, open label with blinded endpoint evaluation parallel group, event driven, multi-centre trial, assessing the impact of CTCA in the diagnosis and management of patients presenting to the ED/AMU with acute chest pain and intermediate high-sensitivity cardiac troponin concentrations.