In the past 20 years since Goldman et al4 described a clinical algorithm to predict MI in ED patients, the clinical ability to decrease the false-negative rate for myocardial events has not improved. Hence, the emergency physician (EP) is compelled to admit to the hospital the majority of patients who present with acute chest pain for further observation and investigation due to inconclusive evidence of ACS or MI during the index ED visit; false-negatives are still sent home with CAD; and false-positives are admitted without CAD; accounting for a significant consumption of resources every year in the US1.