For several years the measurement of serum troponin concentration in patients presenting with acute chest pain has been routine in most hospitals in the United Kingdom. Guidelines now demarcate myocardial infarction with ST elevation from acute coronary syndromes such as unstable angina and myocardial infarction without ST elevation. Since the early 1990s studies have repeatedly confirmed that troponins are released by some patients with acute coronary syndromes and represent a marker of risk for subsequent cardiac events.1^–3 FRISC-II, TACTICS-TIMI 18, and RITA3 all indicate that early angiography and revascularisation can reduce the risk of events in this cohort, thereby improving prognosis.4^–6 As a consequence, management of acute coronary syndromes without ST elevation has changed dramatically in the United Kingdom.7

Formerly, patients were treated medically and considered for early revascularisation if they had ongoing ischaemia, which represents only about 10% of such a group. By contrast, current guidelines …