New high-sensitivity cardiac troponin (hs-cTn) assays have been developed that can measure troponin values at much lower levels. How these new assays should be integrated into clinical practice is an area of active discussion and research. This review addresses how the identification of more high-risk patients with acute coronary syndrome may improve clinical outcomes in these patients. With the advent of the new hs-cTn assays, more patients with unstable angina will be classified as having non-ST-elevation myocardial infarction. These assays will define a high-risk patient population that was not possible with older generation assays. One study suggests that this will lead to more appropriate therapy in these patients and improved outcomes. The use of hs-cTn assays will identify more high-risk patients among millions of patients who present to the Emergency Departments each year with undifferentiated chest pain. This will likely translate into more appropriate care and improved outcomes in this difficult patient population when ECG findings and clinical presentation do not suggest a clear diagnosis.