Perspective:

The authors interpret their findings as suggestive of a potential role for hs-TnI in the evaluation of chest pain as an alternative to imaging, which may be costly and not available. In the discussion, they provide the example of “high” concentrations (remains undefined) being potentially a trigger to directly proceed to angiography rather than stress testing. The study design and findings do not provide the framework to make such implications. The tools available for risk stratification of patients with cardiovascular disease are numerous and extend beyond biomarkers. However, their usefulness is defined by the availability of strategies that would alter that risk. In the absence of those strategies, advocating for widespread use of an ultrasensitive hs-TnI measurement at ranges generally defined as low risk may lead to overutilization of resources, increase in iatrogenic complications, and unnecessary patient and provider anxiety.