{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:23:35Z","timestamp":1793237015417,"version":"4.5.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"Importance<\/jats:title>The European Society of Cardiology (ESC) 0\/1-hour algorithm is a validated high-sensitivity cardiac troponin (hs-cTn) protocol for emergency department patients with possible acute coronary syndrome. However, limited data exist regarding its performance in patients with known coronary artery disease (CAD; prior myocardial infarction [MI], coronary revascularization, or \u226570% coronary stenosis).<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate and compare the diagnostic performance of the ESC 0\/1-hour algorithm for 30-day cardiac death or MI among patients with and without known CAD and determine if the algorithm could achieve the negative predictive value rule-out threshold of 99% or higher.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a preplanned subgroup analysis of the STOP-CP prospective multisite cohort study, which was conducted from January 25, 2017, through September 6, 2018, at 8 emergency departments in the US. Patients 21 years or older with symptoms suggestive of acute coronary syndrome without ST-segment elevation on initial electrocardiogram were included. Analysis took place between February and December 2022.<\/jats:p><\/jats:sec>Interventions\/Exposures<\/jats:title>Participants with 0- and 1-hour high-sensitivity cardiac troponin T (hs-cTnT) measures were stratified into rule-out, observation, and rule-in zones using the ESC 0\/1-hour hs-cTnT algorithm.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Cardiac death or MI at 30 days determined by expert adjudicators.<\/jats:p><\/jats:sec>Results<\/jats:title>During the study period, 1430 patients were accrued. In the cohort, 775 individuals (54.2%) were male, 826 (57.8%) were White, and the mean (SD) age was 57.6\u2009(12.8) years. At 30 days, cardiac death or MI occurred in 183 participants (12.8%). Known CAD was present in 449 (31.4%). Among patients with known CAD, the ESC 0\/1-hour algorithm classified 178 of 449 (39.6%) into the rule-out zone compared with 648 of 981 (66.1%) without CAD (P<\/jats:italic>\u2009&amp;lt;\u2009.001). Among rule-out zone patients, 30-day cardiac death or MI occurred in 6 of 178 patients (3.4%) with known CAD and 7 of 648 (1.1%) without CAD (P<\/jats:italic>\u2009&amp;lt;\u2009.001). The negative predictive value for 30-day cardiac death or MI was 96.6% (95% CI, 92.8-98.8) among patients with known CAD and 98.9% (95% CI, 97.8-99.6) in patients without known CAD (P<\/jats:italic>\u2009=\u2009.04).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Among patients with known CAD, the ESC 0\/1-hour hs-cTnT algorithm was unable to safely exclude 30-day cardiac death or MI. This suggests that clinicians should be cautious if using the algorithm in patients with known CAD. 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