Article Text

Download PDFPDF
Understanding cardiac troponin part 2: early rule out of acute coronary syndrome
  1. Edward Carlton1,
  2. Richard Body2,3,4
  1. 1 Emergency Department, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
  2. 2 The University of Manchester, Manchester, UK
  3. 3 Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK
  4. 4 Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Dr Edward Carlton, Emergency Department, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK; eddcarlton{at}


Chest pain of suspected cardiac origin is a very common emergency department presentation. Over the past decade, there has been an exponential growth in strategies that promote blood sampling at earlier and earlier time points after presentation to facilitate the rule out of acute coronary syndrome.

In part 2 of this series, we examine key concepts from the recent literature with the aim of improving clinicians’ understanding of the rule-out strategies available to them and provide a structured overview of strategies that facilitate discharge with blood testing over <3 hours.

  • acute myocardial infarct
  • acute coronary syndrome

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Both authors drafted and finalised the content of this manuscript.

  • Funding During the preparation of this manuscript, the National Institute for Health Research (NIHR) paid for protected research time covering the majority of RB’s salary (ref PDF-2012-193).

  • Competing interests EC has undertaken research under collaborative agreements with Randox Laboratories and Abbott. RB accepted provision of travel and accommodation to present at scientific symposia sponsored by Roche Diagnostics in 2009, 2014 and 2017; and his institution has received a research grant from Abbott Point of Care.

  • Provenance and peer review Not commissioned; externally peer reviewed.