With Non-STelevation ACS, also low increases in troponin levels detected by highly sensitive assays were reported to be associated with a higher risk of cardiovascular death and myocardial infarction at 30 days and at 1 year. It is well known, that hs-cTnT is superior to MPO for rapid and accurate diagnosis of acute myocardial infarction among patients presenting with chest pain at the emergency department. Interestingly, MPO was not predictive for CE in patients with clinical TIMI risk score #3, whereas it was predictive in patients with higher risk scores. On the contrary, with increasing clinical TIMI risk scores, c-cTnT and hs-cTnT showed a gradual decline of the AUC for the prediction of CE within 30 days. Hence, risk prediction of biomarkers such as hs-cTnT and MPO clearly depends on the pretest probability. Further studies are needed to understand the different risk prediction profiles of hs-cTnT and MPO in low- and high-risk patients with suspected ACS. Interestingly, no improvement in risk prediction was observed with the combination of the clinical TIMI risk score and hs-cTnT with the pre-specified cut-off value of 13 pg/mL. Hence, in line with previous data, the recommended and arbitrary defined hs-cTnT decision limit seems to be less important for CE risk prediction than continuous hs-cTnT levels including also low-level increases. Furthermore, cut-off values of hs-cTnT may differ in various patient populations as has been suggested for other biomarkers such as NT-proBNP which shows dependency on age, gender, and body mass index. Limitations of this study are the single-centre design and the fact that risk assessment was only performed at time of presentation to the emergency department. However, this approach is in accordance with the original design of the TIMI risk score for prognostication at time of presentation. The rather high rate of patients presenting with ST-elevation myocardial infarction observed might at least in part be due to the fact that the study was performed at a tertiary referral center. However, the high rate of coronary angiographies associated with this constellation allowed for confirming or ruling out the diagnosis of coronary artery disease based on current gold standard. Nevertheless, the fact that decision making relied on c-cTnT measurements might have led to an underestimation of true ACS needing validation. As binary data whether events occurred or not were recorded in the study, time-to-event analyses could not be included. In conclusion, the combination of the patients’ clinical condition as represented in the clinical TIMI risk score, and a biomarker approach involving levels of continuous hs-cTnT, best predicted 30-day CE rate in Non-ST-elevation patients; thus, in this heterogeneous patient population the traditional but nevertheless sustainable clinical assessment remains fundamental for risk stratification.