Delays in confirming the diagnosis may increase the risk of complications, and missing it may have fatal consequences for the patient.3 4 Until recently, the triage tools used by emergency physicians clinical symptoms, history, 12 lead electrocardiogram, and standard troponin assays did not allow early exclusion of evolving acute myocardial infarction. To avoid inadvertent discharge home, approximately 80% of all patients with chest pain were admitted to hospital for clinical observation and further testing, despite the fact that only a small proportion of them (approximately 25%) were eventually diagnosed as having myocardial infarction.5The need to triage patients with chest pain more effectively and efficiently to avoid unnecessary hospital admissions and to speed up the diagnostic process has driven the development of the so called high sensitivity cardiac troponin assays. To be classified as high sensitivity, a cardiac troponin assay should meet two criteria: firstly, its total imprecision (coefficient of variation) at the 99th centile of the healthy reference population should be 10% or less; secondly, measureable concentrations above the limit of detection and below the 99th centile should be attainable for at least 50% of the reference population.6 Over the past few years in the United Kingdom, standard troponin assays have gradually been replaced with high sensitivity ones.To improve this situation, the National Institute for Health and Care Excellence (NICE) has recently published guidance on the clinical application of high sensitivity troponin assays in the early rule out of acute myocardial infarction.
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