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OBJECTIVE The HEART score is a clinical decision support tool for physicians to stratify the risk of major adverse cardiac events (MACE) in patients presenting with chest pain at the emergency department (ED). The score includes 5 elements, including troponin level. Our aim was to compare safety and efficiency of the HEART scores calculated by using the first representative troponin (i.e. based on time since symptom onset) compared to the original HEART score, where calculation was based on the first available troponin measurement, irres