External Validation of the No Objective Testing Rules in Acute Chest Pain

Ratmann, P., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Koechlin, L., Wildi, K., Miro. O., Martin-Sanchez, F.J., Christ, M., Twerenbold, R., Gimenez, M.R., Keller, D., & Mueller, C (2021), “External Validation of the No Objective Testing Rules in Acute Chest Pain” Journal of the American Heart Association, 10(10)

Rapid high‐sensitivity cardiac troponin (hs‐cTn) based algorithms have substantially improved the early rule out of acute myocardial infarction (AMI) and thereby facilitated the selection of patients eligible for outpatient management.1, 2 However, it remains unclear which patients after rule out of AMI should still undergo objective anatomic or functional cardiac testing for the detection of coronary artery disease (CAD) and which not. A pilot study using a 0/2‐hour rule‐out protocol derived combinations of clinical variables, the so‐called No Objective Testing (NOT) rules (Figure), for selection of patients who may not need objective anatomic or functional cardiac testing for CAD.3 Hence, we aimed to externally validate the performance of the 3 NOT models in a large, prospective, international multicenter study.