Evaluation of Serial Troponin and Cardiac Multimarkers at the Point of Care in the Emergency Department

Inclusion Criteria: * 18 years of age or older at time of enrollment * Presenting to the ED within 6 hours from onset of chest discomfort (pain, pressure, tightness, etc) consistent with a possible diagnosis of AMI or ACS and with an initial ECG non-diagnostic for injury (or injury equivalent resulting in emergent reperfusion therapy). (NOTE: Subjects who have chest discomfort that is episodic or stuttering in nature may be included if the ED presentation is within 6 hours of symptom onset.) * Experiencing at least 30 minutes of chest pain or other anginal equivalent symptoms. (Note: Subjects who have symptoms of shorter duration due to pharmacologic intervention may be included.) Exclusion Criteria: * Patient (or Legal Representative) unable or unwilling to provide written informed consent. * Patient unwilling or unlikely to comply with study procedures, including protocol-specified blood sampling or telephone follow-up at 30 days and 6 months. * Vulnerable populations as deemed inappropriate for study by site principal investigator. * ST-elevation or other ECG criteria that result that is diagnostic for AMI and results in patient being sent for percutaneous coronary interventions (PCI) or being treated with thrombolytics6. * Pulmonary Edema requiring CPAP, BIPAP, or mechanical ventilation * Tachyarrhythmias (SVT, V-Tach, rapid atrial fib) * End Stage Renal Disease on Hemodialysis * Cardiac Arrest prior to arrival * Implantable Defibrillator firing prior to arrival * Hemodynamically unstable patients * Trauma injury to the chest