{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:06:58Z","timestamp":1789556818954,"version":"build-2803163510"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,7,1]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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 &lt;12\u2009ng\/L and a 1-hour absolute change &lt;3\u2009ng\/L. Patients undergoing urgent CAG during index hospitalisation comprised the angiographic cohort. Findings were categorised as significant stenosis (\u226570% in a major non-left-main epicardial artery or \u226550% in the left main), intermediate stenosis (50%\u201369% in a non-left-main artery) or non-obstructive coronary artery disease (&lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 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 \u226550% angiographic stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004186","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:05:44Z","timestamp":1783595144000},"page":"e004186","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5346-464X","authenticated-orcid":false,"given":"Abdullah","family":"Avlac","sequence":"first","affiliation":[{"name":"\u0130stanbul \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, \u015ei\u015fli, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4201-8850","authenticated-orcid":false,"given":"Ertu\u011frul","family":"Alt\u0131nbilek","sequence":"additional","affiliation":[{"name":"\u0130stanbul \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, \u015ei\u015fli, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3970-8922","authenticated-orcid":false,"given":"Bedriye M\u00fcge","family":"S\u00f6nmez","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Dokuz Eylul Universitesi Hastanesi, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7318-0725","authenticated-orcid":false,"given":"Derya","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"\u0130stanbul \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, \u015ei\u015fli, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2046-7279","authenticated-orcid":false,"given":"\u0130layda","family":"Civelek","sequence":"additional","affiliation":[{"name":"\u0130stanbul \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, \u015ei\u015fli, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-1949","authenticated-orcid":false,"given":"Selin","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"\u0130stanbul \u015ei\u015fli Hamidiye Etfal E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, \u015ei\u015fli, \u0130stanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026091603500758000_13.2.e004186.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001029"},{"key":"2026091603500758000_13.2.e004186.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.08.750"},{"key":"2026091603500758000_13.2.e004186.3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.14740\/cr1432","article-title":"A Closer Look at the HEART Score","volume":"13","author":"Aung","year":"2022","journal-title":"Cardiol Res"},{"key":"2026091603500758000_13.2.e004186.4","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuad107"},{"key":"2026091603500758000_13.2.e004186.5","doi-asserted-by":"crossref","unstructured":"Sanfilippo FM , Murray K , Hillis GS , et al . 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