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This trial found that computed tomography coronary angiography did not alter 1-year all-cause death or subsequent myocardial infarction, but it did increase length of hospital stay and health-care cost.

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Alasdair J Gray 1,2,*, Carl Roobottom 3, Jason E Smith 4, Steve Goodacre 5, Katherine Oatey 6, Rachel O’Brien 2, Robert F Storey 7, Nick Curzen 8, Liza Keating 9, Attila Kardos 10, Dirk Felmeden 11, Robert J Lee 6, Praveen Thokala 5, Steff C Lewis 6, David E Newby 12,13

1 Usher Institute, University of Edinburgh, Edinburgh, UK
2 Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
3 Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
4 Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
5 School of Health and Related Research, University of Sheffield, Sheffield, UK
6 Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
7 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
8 Faculty of Medicine, University of Southampton and Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
9 Department of Emergency Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
10 Department of Cardiology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
11 Department of Cardiology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
12 Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
13 Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
* Corresponding author Email: alasdair.gray@ed.ac.uk

Declared competing interests of authors: Alasdair J Gray is a member of the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) Prioritisation Committee (2019–present). Steve Goodacre is the chairperson of the NIHR Clinical Trials Unit Standing Advisory Committee (2019–present). He was the deputy director of the NIHR HTA programme (2019–20); chairperson of the NIHR HTA Commissioning Committee (2019–20); and a member of the HTA Post-Funding Committee, HTA Funding Committee Policy Group and HTA Programme Oversight Committee (2019–20). Robert F Storey reports consultancy fees from Bayer (Leverkusen, Germany), Bristol-Myers Squibb/Pfizer (New York, NY, USA), AstraZeneca (Cambridge, UK), Thromboserin (Midhurst, UK), Haemonetics (Boston, MA, USA), Amgen (Thousand Oaks, CA, USA), Glycardial Diagnostics (Barcelona, Spain), Portola (South San Francisco, CA, USA), Cytosorbents (Monmouth Junction, NJ, USA), Hengrui (Princeton, NJ, USA), Sanofi Aventis (Paris, France), Idorsia (Allschwil, Switzerland) and PhaseBio (Malvern, PA, USA); honoraria from Bayer, Bristol-Myers Squibb/Pfizer, AstraZeneca, Medscape (New York, NY, USA) and Intas Pharmaceuticals (Ahmedabad, India); and institutional research grants from AstraZeneca, Thromboserin, Glycardial Diagnostics and Cytosorbents. Nick Curzen reports grants, speaker fees and travel sponsorship from Haemonetics, Boston Scientific (Marlborough, MA, USA) and HeartFlow (Redwood City, CA, USA); grants from Beckmann Coulter (Brea, CA, USA); speaker fees from Abbott (Chicago, IL, USA); travel sponsorship from Biosensors (Singapore), Edwards (Irvine, CA, USA) and Medtronic (Dublin, Ireland); and consultancy from HeartFlow, Boston Scientific, Abbott and Haemonetics. Steff C Lewis was a member of the NIHR HTA General Committee (2016–21) and was a member of the NIHR HTA Efficient Study Designs Board (2015–16). David E Newby reports unrestricted educational grants from Siemens Healthineers (Erlangen, Germany).

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