We have been searching for a tool to identify myocardial infarction patients who are truly safe for discharge ever since Pope, et al., found that we were discharging two percent of patients with MIs from the emergency department. Many have anointed the high-sensitivity troponin assay (hs-cTnI) for this role. The added sensitivity would identify a subset of ACS patients who would otherwise remain occult during their ED stay—in theory. Such a sensitivity could come with a loss of specificity, a heavy price when the incidence of disease is low. Despite the theoretical advantages of hs-cTnI, evidence supporting its use is inconsistent at best. Now, with the recent publication of a cluster-randomized controlled trial by Shah, et al., we have evidence demonstrating the clinical consequences of high-sensitivity assays on patient care.

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