There is a dichotomy in the assessment of patients with
possible ACS. First, early and accurate identification of
patients with ST-segment-elevation myocardial infarction
(STEMI) enables provision of emergency reperfusion therapy,
which has a major impact on outcome, while accurate
identification of patients with other types of ACS (non-STsegment
elevation myocardial infarction [NSTEMI] or
unstable angina) allows for early initiation of targeted treatment
known to improve outcomes in these groups. Second,
accurate exclusion of myocardial ischaemia in patients with
chest pain is essential to minimise the morbidity and mortality
associated with missed diagnoses, while avoiding
unnecessary overinvestigation in those without the disease.
However, assessment is complex because of the diversity of
clinical presentations of ACS and the lack of a single
diagnostic test for the entire spectrum of disease.