### Learning objectives Chest pain is a common presentation to the emergency department and can be caused by a range of conditions including acute myocardial infarction. However, only 1 in 10 patients with symptoms suggestive of acute coronary syndrome are ultimately diagnosed with myocardial infarction.1 As such, effective pathways are required to enable the prompt and safe rule-out of the majority of patients with non-cardiac presentations and the rapid identification of those with myocardial infarction. Recently published guidelines from the National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC) have recommended the use of early rule-out pathways for myocardial infarction,2 3 enabled by the increased analytical precision of high-sensitivity cardiac troponin (hs-cTn) testing.4 These guideline recommendations are supported by recent randomised trials that have provided new insights into the safety and effectiveness of these pathways in clinical practice.5–7 Multiple pathways have been proposed that vary according to the thresholds used for decision-making and timing of sampling. Implementing a validated pathway could save healthcare resources and improve the safe delivery of patient care. Here we describe these early rule-out pathways, review their supporting evidence and provide practical advice for their adoption in clinical practice. Cardiac troponin is a highly specific marker of cardiomyocyte injury, which can be detected in the circulation within an hour of the onset of myocardial ischaemia.8 High-sensitivity assays have sufficient analytical precision to quantify very low concentrations of cardiac troponin in the majority of healthy people.9 The …

中文翻译：

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在临床实践中实施急性心肌梗死的早期排除途径

### 学习目标 胸痛是急诊科的常见表现，可由包括急性心肌梗塞在内的多种疾病引起。然而，只有十分之一的症状提示急性冠脉综合征的患者最终被诊断为心肌梗塞。快速识别心肌梗死患者。美国国家健康与护理卓越研究所 (NICE) 和欧洲心脏病学会 (ESC) 最近发布的指南建议使用早期排除心肌梗塞的途径，2 3 通过提高高灵敏度的分析精度实现心肌肌钙蛋白（hs-cTn）检测。4 这些指南建议得到了近期随机试验的支持，这些试验为这些途径在临床实践中的安全性和有效性提供了新的见解。 5-7 已经提出了多种途径，这些途径根据用于决策和采样时间的阈值而有所不同. 实施经过验证的途径可以节省医疗资源并提高患者护理的安全性。在这里，我们描述了这些早期排除途径，回顾了它们的支持证据，并为它们在临床实践中的采用提供了实用的建议。心肌肌钙蛋白是心肌细胞损伤的高度特异性标志物，可在心肌缺血发作后 1 小时内在循环中检测到。