Background
myocardial infarction, acute chest pain, coronary artery disease, cardiac death
MYOCARDIAL INFARCTION, CORONARY ARTERY DISEASE, CARDIAC DEATH
Patients with acute chest pain account for a tenth of all presentations to the emergency department and up to 40% of unplanned hospital admissions, with their assessment placing a major burden on health care resources [Patients with cardiac troponin concentrations below the 99th centile upper reference limit on serial testing do not have myocardial infarction but may still have underlying coronary artery disease [We previously reported that patients with cardiac troponin I concentrations < 5 ng/L are at very low risk, with a negative predictive value of 99.6% for a composite endpoint of myocardial infarction or cardiac death at 30 days [Similar approaches are now used in multiple accelerated diagnostic pathways [We postulate that patients with acute chest pain and intermediate-risk high-sensitivity cardiac troponin concentrations will benefit from further investigation for coronary artery disease soon after discharge.