The assessment of patients with symptoms suggestive of acute myocardial infarction (AMI) can be a diagnostic challenge and time-consuming, given the need for serial blood sampling for 6 to 9 hours. The recently developed high-sensitivity cardiac troponin T (hs-cTnT) assay can detect smaller amounts of cardiac troponin faster than former generations of cardiac troponin assays. Reichlin et al derived and validated an algorithm for the diagnosis of AMI in 872 patients with chest pain in the emergency department. Overall, the algorithm incorporating hs-cTnT baseline values and absolute changes within the first hour resulted in a definite diagnosis in 77% of unselected patients with acute chest pain within 1 hour. Sensitivity and negative predictive value for rule-out were 100%, and specificity and positive predictive value for rule-in were 97% and 84%, respectively, therefore allowing for a safe rule-out as well as an accurate rule-in of AMI within 1 hour. This novel strategy may obviate the need for prolonged monitoring and serial blood sampling in 3 of 4 patients.