Diagnostic Performance of Artificial Intelligence Algorithms in Prediction of Acute Coronary Syndrome Based on White Blood Cell Properties

Inclusion Criteria: General inclusion criteria: * Male or female, aged 18 years or above. * Participant is willing and able to give informed consent for participation in the study. * Collection of WBC and hs-cTn data must be possible. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data must be fulfilled, where applicable. Case cohort: * Suspicion of STEMI or NSTE-ACS according to current ESC guidelines. * Coronary angiography must have been performed within 72 hours after initial suspicion of ACS. * For patients qualifying for observation according to ESC guidelines, coronary angiography is not mandatory and time limits do not apply. * Confirmation of STEMI or NSTE-ACS by identification of a culprit lesion using coronary angiography; identical evaluation results by review board required. * For observation patients without coronary angiography, final discharge diagnosis is used to decide about the presence or absence of NSTEMI and/or ACS. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data must be fulfilled. Control cohort: * Suspicion of STEMI or NSTE-ACS according to current ESC guidelines. * Coronary angiography must have been performed within 72 hours after initial suspicion of ACS. * No identification of a culprit lesion compatible with diagnosis of STEMI or NSTE-ACS during coronary angiography; identical evaluation results by review board required. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data must be fulfilled. Supplementary cohort: * Subject presents without chest pain or with stable angina pectoris. * No indication for revascularization during coronary angiography; identical evaluation results by review board required. * Exclusion of elevated hs-cTn. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data must be fulfilled. * Between initial blood sampling to collect WBC data and coronary angiography, the subject must not develop suspicion of ACS. Rule-out cohort: * Suspicion of NSTE-ACS and NSTEMI rule-out according to current ESC guidelines, i.e. very low initial hs-cTn value, or low initial hs-cTn value and no significant 1-hour/2-hour change in hs-cTn value. * No coronary angiography within 72 hours. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data must be fulfilled. All-comer cohort: * Subject presents to the emergency department with suspected ACS. * Clinical assessments, ECG, and measurements of hs-cTn, single or serial measurement, must be conducted according to ESC guidelines. * Collection of WBC data must be performed at initial blood withdrawal after admission to the emergency department. * Review board evaluations must confirm the presence or absence of a culprit lesion if coronary angiography was performed, as outlined for the case and control cohorts. Exclusion Criteria: * Age below 18 years. * Subject refuses informed consent. * Collection of WBC and hs-cTn data is not possible. * Criteria for timing of blood sampling for collection of WBC and hs-cTn data cannot be fulfilled. * Suspicion of ACS occurs in subjects with no or stable angina pectoris any time between initial blood sampling and start of coronary angiography.