The sample size was calculated based on a negative predictive value of 97.5%, as established previously [7 (link)]. The sensitivity, specificity, α error, β error, and prevalence rate were set as 84%, 88%, 0.05, 0.10, and 10%, respectively. The prevalence of AMI in adults who visit the ED for nontraumatic chest pain differs in the literature and is reported to range from 4% to 17% [3 (link),18 (link)]. The study sample size was calculated based on a 10% prevalence rate. However, based on a dropout rate of 10%, 8,814 participants will be ultimately required. This calculation is based on the “bdpv” library of R ver. 4.1.0 (R Foundation for Statistical Computing) and a corresponding study [19 (link)].