Effectiveness of rapid rule-out strategy for acute coronary syndrome in the emergency department: a real-world retrospective study in Asia

The ESC 0/1 h hs-cTnT algorithm demonstrated good diagnostic concordance in the rule-in group and high safety in the rule-out group, but nearly half of the patients remained in the observe category, limiting operational efficiency. The 2020 threshold adjustments reclassified more patients as rule-in or rule-out but did not enhance diagnostic yield. These findings suggest that while the algorithm can support early decision-making, its thresholds may require recalibration to local populations and clinical practice settings.