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  1. Sally Aldous1,
  2. Chris Pemberton2,
  3. A Mark Richards2,3,
  4. Richard Troughton1,
  5. Martin Than4
  1. 1Cardiology Department, Christchurch Hospital, Christchurch, New Zealand
  2. 2Christchurch Cardioendocrine Research Group, University of Otago, Christchurch, New Zealand
  3. 3Cardiovascular Research Centre, NUHS, Singapore, Singapore
  4. 4Emergency Department, Christchurch Hospital, Christchurch, New Zealand
  1. Correspondence to Dr Sally Aldous, Cardiology department, Christchurch Hospital, Riccarton Road, Christchurch 8024, New Zealand; sally.aldous{at}cdhb.govt.nz

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Carlton and Greaves1 raise some important issues in response to our recent article1a regarding the implications of implementing high sensitivity troponin assays and other risk scores for investigation of patients with acute coronary syndromes.

The aim of evaluation of patients with possible acute coronary syndrome in the Emergency Department is to identify whether patients require admission (to inpatient care or observation unit depending on hospital facilities). As patients with missed acute coronary syndrome (ACS)/acute myocardial infarction (AMI) are at a higher risk of adverse events,2 strategies used to identify those not requiring admission require high sensitivity and negative predictive value. As a highly sensitive tool for the diagnosis of AMI, high sensitivity cardiac troponin (hs-cTn) is appealing for this task.3–5 Although …

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