The use of high-sensitive troponin is recommended by international guidelines to diagnose or to rule out acute myocardial infarction (AMI). The 99th percentile in combination with an absolute or relative change (baseline and 3 h later) of troponin has been suggested to triage patients in the emergency department. For ruling in, two distinct pathways are proposed: when the first measurement is below the 99th percentile of the troponin assay and the second one is above it, an relative delta of 50% is required to diagnose AMI. When both measurements are above the 99th percentile, a relative delta of 20% is required. For ruling out, both values should be below the 99th percentile. While this approach is used in clinical routine, the experience with newer more sensitive troponin assays is limited. Nevertheless, more sensitive assays may offer better performance, therefore limiting time until the final diagnosis can be made. In this view, different algorithms using different troponin assays have been reported and are represented in the current European Society of Cardiology (ESC) guidelines.1 Importantly, each individual troponin assay has a different sensitivity and requires individual cut-off concentrations to rule in or rule out AMI.2 That …