One of the most common reasons for Emergency Department (ED) visits is chest pain. While most of these presentations are at a low risk for cardiac events, it is generally required to perform a full work-up to rule out an Acute Coronary Syndrome (ACS), including an Acute Myocardial Infarction (AMI), before being discharged responsibly.

The biggest challenge for physicians is to not only identify patients who are likely to have ACS but also to identify low risk patients that can be safely discharged without prolonged stays for further investigation.

The current standard of practice, including risk assessment protocols, recommend using serial troponin testing and detection of absolute changes in troponin levels to rule out AMI in the ED.

Recent studies using high sensitivity troponin (hsTnT) have shown that if the initial troponin is very low, one troponin may be sufficient to safely discharge patients from the ED, especially when combined with the HEART score.

In practice however, in countries where hsTnT is not generally available, some clinicians have adopted this strategy using conventional troponin.

This particular practice of using single conventional troponin testing has not been studied well.

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