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Circulation. 2021;144:e368–e454. DOI: 10.1161/CIR.0000000000001029 November 30, 2021 e429 CLINICAL STATEMENTS AND GUIDELINES

low the limit of detection: a collaborative meta-analysis. Ann Intern Med. 2017;166:715–724. 10.	 Peacock WF, Baumann BM, Bruton D, et al. Efficacy of high-sensitivity troponin T in identifying very-low-risk patients with possible acute coronary syndrome. JAMA Cardiol. 2018;3:104–111. 11.	 Neumann JT, Twerenbold R, Ojeda F, et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med. 2019;380:2529–2540. 12.	 Greenslade JH, Carlton EW, Van Hise C, et al. Diagnostic accuracy of a new high-sensitivity troponin I assay and five accelerated diagnostic pathways for ruling out acute myocardial infarction and acute coronary syndrome. Ann Emerg Med. 2018;71:439–451, e3. 13.	 Cullen L, Mueller C, Parsonage WA, et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol. 2013;62:1242–1249. 14.	 Flaws D, Than M, Scheuermeyer FX, et al. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP) Emerg Med J. 2016;33:618–625. 15.	 Stopyra JP, Miller CD, Hiestand BC, et al. Validation of the no objective testing rule and comparison to the HEART Pathway. Acad Emerg Med. 2017;24:1165–1168. 16.	 Than M, Aldous S, Lord SJ, et al. A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial. JAMA Intern Med. 2014;174:51–58. 17.	 Twerenbold R, Boeddinghaus J, Nestelberger T, et al. Clinical use of highsensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017;70:996–1012. 18.	 Mahler SA, Lenoir KM, Wells BJ, et al. Safely identifying emergency department patients with acute chest pain for early discharge. Circulation. 2018;138:2456–2468. 19.	 Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–e426. 20.	 Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8:195–203. 21.	 Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic pro-

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4.1.1.1 Cost-Value Considerations in the Evaluation of Low-Risk Patients

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4.1.2 Intermediate-Risk Patients With Acute Chest Pain

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