The topic of diagnosis and management of patients presenting to the emergency departments (ED) with acute chest pain of suspected cardiac origin and electrocardiogram (ECG) negative for ST-elevation myocardial infarction (STEMI) is of current importance. More than 12 million patients present to the ED with suspected acute myocardial infarction (AMI) each year in Europe and North America, resulting in considerable resource use and contributing to the overcrowding of EDs [
1]. Recent Italian data showed that while the incidence of patients presenting with STEMI has significantly decreased over the past decade, that of NSTEMI has slightly increased. Given that prevalence, early identification of low-risk patients eligible for early discharge is crucial to ensure the efficiency and effectiveness of the health system. If on one hand, the high mortality associated with myocardial infarction (MI) requires timely diagnosis to ensure adequate and timely treatments, on the other hand, the high number of patients who present to ED and who have a diagnosis other than acute coronary syndromes (ACS) requires that clinicians can rapidly rule out the diagnosis of MI in low-risk patients [
2]. High-sensitivity troponin I and T (hsTnI and hsTnT) assays have been introduced in clinical practice with the aim to detect smaller amounts of myocardial injury in a shorter time, therefore, their role is critical in those patients presenting with symptoms suggestive for ACS and a normal or inconclusive ECG [
2‐
5]. In patients with serial low hsTn values, the diagnosis of myocardial infarction can be safely excluded (and patients can be early discharged safely, reducing the rate of inappropriate hospitalizations), while in ACS patients, they allow a reduction in time interval between hospitalization and diagnosis, turning in prompt treatment, better patients’ outcomes, as well as economical and organizational benefits [
4,
6]. However, to date, there is great heterogeneity in the management of NSTEMI patients and in the utilization of different cardiac troponin assays for its diagnosis in the ED all-over Italy [
4]. …
