ArticleOpen heart2026
Coronary angiography findings in emergency department chest pain patients undergoing angiography despite hs-cTnT-based early rule-out angiography after hs-cTnT rule-out in ED chest pain.
Article in Open heart, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh-sensitivity cardiac troponin (hs-cTn) algorithms are established for early rule-out of acute myocardial infarction, but coronary angiographic (CAG) findings in emergency department (ED) patients undergoing invasive evaluation despite fulfilling rule-out criteria remain insufficiently described.
objectiveTo characterise the coronary anatomy and clinical profile of ED patients with chest pain undergoing urgent CAG despite fulfilling hs-cTnT-based early rule-out criteria.
methodsThis retrospective single-centre study included adults with suspected acute coronary syndrome from 1 January 2020 to 1 January 2023. All patients fulfilled the serial European Society of Cardiology 0/1-hour rule-out pathway, defined as baseline hs-cTnT <12 ng/L and a 1-hour absolute change <3 ng/L. Patients undergoing urgent CAG during index hospitalisation comprised the angiographic cohort. Findings were categorised as significant stenosis (≥70% in a major non-left-main epicardial artery or ≥50% in the left main), intermediate stenosis (50%-69% in a non-left-main artery) or non-obstructive coronary artery disease (<50%). Baseline and 1-hour hs-cTnT concentrations, 1-hour and relative 1-hour changes, History, ECG, Age, Risk factors and Troponin (HEART) scores and angiographic findings were compared.
resultsOf 646 patients, 376 underwent urgent CAG. Significant stenosis was found in 109 (29.0%), intermediate stenosis in 220 (58.5%) and non-obstructive disease in 47 (12.5%). Baseline and 1-hour hs-cTnT concentrations and HEART scores differed significantly across angiographic categories, with the highest values in the significant stenosis group and the lowest in the non-obstructive group. The 1-hour and relative 1-hour hs-cTnT changes also differed overall, although significant pairwise differences were limited to the intermediate and non-obstructive groups. Relative hs-cTnT change showed limited discrimination for non-obstructive disease, whereas the HEART score showed moderate discrimination for ≥50% angiographic stenosis.
conclusionsAmong selected ED patients undergoing urgent CAG despite hs-cTnT-based rule-out, intermediate or significant stenosis was common. These findings descriptively characterise coronary anatomy in this cohort but do not establish culprit-lesion status, functional significance, appropriateness of angiography or failure of the hs-cTnT rule-out algorithm.
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