Management of patients with chest pain presenting to the emergency department: in need for the implementation of the 1 h rapid rule-out algorithm using high-sensitivity troponin I assays in clinical practice

Each year, about 6 million people with acute chest pain present to the emergency department (ED) in the US for diagnostic evaluation. Comparable data are reported from Europe: during the last 20-year period, the number of hospital admissions due to chest pain has tripled in the United Kingdom. In current guidelines, the presence or absence of acute myocardial infarction (MI) is diagnosed by prudent balancing elements of patient history, 12-lead electrocardiogram (ECG) recordings, and dynamic changes of cardiac troponin (cTn) levels above recommended cutoff levels within a 3 h observational period (1). Of note, the majority of these patients does not have MI, but need time consuming evaluation. Due to diagnostic uncertainty and the lack to rule out MI rapidly, some of those patients are being hospitalized. To reduce the length of stay in the ED and the hospital, new diagnostic pathways are welcome to accelerate the diagnostic evaluation of affected patients with chest pain in the ED (2). Thus, the report of the High-STEACS trial (High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study) recently published in The Lancet is welcome and of major importance (3).