Bularga A, Lee KK, Stewart S, et al. - Via performing a multicenter trial across 10 hospitals in Scotland, researchers examined the performance of 2 risk stratification thresholds for a high-sensitivity cardiac troponin I assay in patients with suspected acute coronary syndrome (n = 48 282) and at least 2 hours of symptoms. Using the Abbott high-sensitivity troponin I assay, a comparison of the performance of the limit of detection (< 2 ng/L) and an optimized risk stratification threshold (< 5 ng/L) was performed in a prespecified secondary and observational analysis. An optimized risk stratification threshold of < 5 ng/L led to recognization of twice as many patients at presentation as low risk compared with the limit of detection (< 2 ng/L), with an equivalent negative predictive value for myocardial infarction or cardiac death at 30 days. Compared with the diagnostic threshold, 80% and 77% lower risk of subsequent cardiac events at 12 months was observed among patients with cardiac troponin I concentrations < 2 ng/L or < 5 ng/L, respectively. These findings support using separate risk stratification and diagnostic thresholds for high-sensitivity cardiac troponin for improving the safety of the assessment of cardiovascular risk in patients with suspected acute coronary syndrome.