Is a single troponin measurement below the level of detection superior to serial troponin measurements for the safe discharge of chest pain patients?

BEEM Bottom Line

Why is this study important?

The rapid and safe discharge of chest pain patients who do not have acute coronary syndrome (ACS) or another serious etiology is a long-term holy grail of emergency medicine. If a single blood test could rule out ACS in a high percentage with a high negative predictive value, it would come near to that holy grail. This trial compares a strategy of a single undetectable below the limit of detection (< LoD) high-sensitivity cardiac troponin (hs-cTn) and non-ischemic electrocardiogram (ECG) to the current standard emergency department (ED) care of serial measurements a hs-cTn to rule out ACS.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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