“…The absence of changes on serial ECG does not preclude life-threatening acute coronary syndromes and other clinical data and tests must be considered in order to determine the need for hospital admission and treatment. In this regard, decision aids such as high-risk clinical indicators, 14,15 rapid determination of cardiac serum markers, 16,17 two-dimensional echocardiogram screening for regional wall motion abnormalities, 18 myocardial perfusion imaging, 19 and computer-based diagnostic aids 20,21 have been proposed in patients in whom the ECG is non-diagnostic. However, in the local emergency departments (ED) setting, only serum cardiac markers are available easily.…”