• acute myocardial infarction

Around one million patients present to hospital with chest pain every year, accounting for approximately 5% of all emergency department attendances in the UK. However, only one in five patients are found to have had a myocardial infarction.1 Therefore, for several years, there has been a drive to develop diagnostic strategies which allow accurate identification of patients without myocardial infarction at an earlier stage, who may not require admission to hospital for serial cardiac biomarker testing. Such strategies have the potential to improve patient experience and optimise resource allocation both in the emergency department and in hospital, at a time of ever-increasing demands.

Cardiac troponin is the biomarker of choice for the detection of myocardial injury, and international guidelines recommend concentrations are measured using a high-sensitivity assay.2 While high-sensitivity assays were first introduced in Europe in 2010, they have only recently become available for use in clinical practice in the USA. The higher precision and lower limits of detection afforded by these tests has facilitated the development of pathways which can rule out myocardial infarction at an earlier stage, the majority of which have demonstrated a magnitude of benefits in diagnostic accuracy compared with using the recommended diagnostic threshold (99th centile) alone.3 4 In practical terms, implementation of these approaches requires investment in infrastructure to deliver accurate and timely cardiac troponin results on a high-sensitivity platform which is not always available.

One potential strategy to improve …