Can CTCA prevent cardiac event after MI ruled out?

In a randomized trial, additional imaging increased preventive treatment but did not significantly reduce subsequent myocardial infarction or cardiac mortality over 3 years.

By
Andrea Surnit
November 12, 2026
4 min

MDSpire News

Objective:

To assess whether CT coronary angiography (CTCA)-guided care reduces subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome after MI has been ruled out.

Approach:

Design and participants: Multicenter, open-label randomized trial at 14 UK hospitals; 3,170 patients with intermediate cardiovascular risk were assigned to CTCA-guided care (1,587) or standard care (1,583).
Follow-up and outcomes: Median follow-up was 3 years. The primary outcome was myocardial infarction or cardiovascular death; secondary outcomes included other cardiovascular events, mortality, repeat visits, revascularization, and major bleeding.

Key Findings:

The primary outcome occurred in 112 patients (7%) assigned to CTCA-guided care and 116 (7%) receiving standard care; the difference was not statistically significant.
Myocardial infarction occurred in 6% of each group; cardiovascular death occurred in 1% with CTCA and 2% with standard care.
All-cause mortality was 5% with CTCA and 6% with standard care. Much of the difference reflected noncardiovascular deaths; secondary analyses were not adjusted for multiple comparisons.
CTCA-guided care was associated with higher statin and antiplatelet use. Revascularization occurred in 6% versus 5%, respectively.
A HEART-score subgroup analysis suggested a possible primary-outcome benefit among low-risk patients, but subgroup findings warrant caution because of multiple comparisons.
CTCA-related adverse events occurred in 7 patients (0.4%); three were classified as serious, with symptoms resolving without intervention or after antihistamine treatment.

Interpretation:

The trial authors reported that CTCA-guided care did not reduce subsequent myocardial infarction or cardiovascular death compared with standard care. The observed all-cause mortality and subgroup differences require cautious interpretation.

Limitations:

The primary-outcome event rate was lower than anticipated, and the findings remained compatible with both a reduction and an increase in cardiovascular risk.
Most participants were men; some had established coronary artery disease or were already receiving preventive treatment.
The trial was conducted only in the UK, where coronary imaging is used relatively infrequently in routine care.
Secondary analyses were not adjusted for multiple comparisons.

Conclusion:

In this trial, CTCA-guided care did not significantly reduce the composite of myocardial infarction or cardiovascular death among patients whose initial evaluation ruled out MI.