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Chest Pain Evaluation. Implementation Support Guide — Clinicans' Summary . To improve patient safety by implementing minimum standards for chest pain evaluation in NSW . Failure to undertake appropriate investigations, e.g. ECG, Troponin testing. • Failure to This led to an inability to identify ST elevation on ECG Troponin as a marker of Myocardial Infarction. A Diagnosis of a Myocardial Infarction (MI) requires careful clinical evaluation, particularly of chest pain31 Oct 2018 "Highly sensitive" or "high sensitivity" troponin tests are available for clinical use 72:2231. www.accessdata.fda.gov/cdrh_docs/reviews/K162895.pdf. Cardiac troponin T in chest pain unit patients without ischemic If Troponin measured > 6 - 8 hours after the onset of chest pain is negative, 4. In patients with background elevations of troponin (e.g. patients with CRF),. However, elevated cardiac troponin levels are not specific for the diagnosis of ACS or ACS conditions may overlap with symptoms of ACS (e.g., chest pain or