Pre-hospital Rule-out of Acute Coronary Syndrome

Inclusion criteria: * Age at least 18 years; male ánd female * All out-of-hospital patients with chest pain or symptoms suggestive of ACS initially visited by an ambulance with an indication for transfer to a hospital to evaluate and rule out ACS * Symptom duration for at least two hours * Modified HEAR(T) score less or equal than 3 * A point of care troponin below the upper reference limit (for patients stratified to pre-hospital management by the general practitioner) * The patient has been informed of the nature of the study, agrees to its provisions and has provided written informed consent. Exclusion criteria: * Electrocardiographic ST-segment elevation * Patients presenting an obvious non-cardiac cause for the chest complaints who need evaluation at an emergency department, e.g. trauma, pneumothorax, sepsis, etc. * Patients in comatose state, defined as an Glascgow coma scale (GCS) \<8 * Patients with known cognitive impairment * Pregnancy or intention to become pregnant during the course of the study * Patients presenting cardiogenic shock, defined as: systolic blood pressure \<90 mmHg and heart rate \>100 beats per minute and peripheral oxygen saturation \<90% (without oxygen administration) * Patients presenting with syncope * Patients presenting with signs of heart failure * Patients presenting with heart rhythm disorders and second or third degree atrioventricular block * Patients with known end-stage renal disease (dialysis and/or glomular filtration rate (GFR) \< 30 ml/min) * Patients without a pre-hospital 12-lead ECG performed or available * Patients suspicious of aortic dissection or pulmonary embolism * Patients with confirmed acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting \<30 days prior to inclusion * Communication issues with patient/language barrier * Decision of a present general practitioner to evaluate the patient at the emergency department (ED) * Decision of the consultant cardiologist to evaluate patient at the ER irrespective of HEART score * Any significant medical or mental condition, which in the Investigators opinion may interfere with the patients optimal participation in the study