Pre Hospital Triage of Patients at Intermediate and High Risk for ACS

Inclusion Criteria: * Age ≥ 18 years * All out-of-hospital patients with chest pain or symptoms suggestive of ACS with an indication for transfer to the (cardiac) emergency department to evaluate and rule out ACS * Modified HEAR(T) score ≥ 4 * 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 (STEMI) * Patients with confirmed myocardial infarction, PCI or CABG \<14 days prior to inclu-sion * 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 EMV \<8 * Patients with known cognitive impairment * Pregnancy * Patients presenting with cardiogenic shock, defined as: systolic blood pressure \<90mmHg and heart rate \>100 and peripheral oxygen saturation \<90% (without oxygen administration) * Patients presenting with syncope * Patients presenting with signs of heart failure * Patients presenting with second or third degree atrioventricular block * Patients without known supraventricular tachycardia i.e. unknown atrial fibrillation (known atrial fibrillation with adequate rate control can be included) * Patients with known end-stage renal disease (dialysis and/or GFR \< 30 ml/min) * Patients without a pre-hospital 12-lead ECG performed or available * Patients suspicious of aortic dissection or pulmonary embolism * Communication issues with patient/language barrier * Any significant medical or mental condition, which in the Investigator's opinion may interfere with the patient's optimal participation in the study