Chapman AR, Adamson PD, Shah ASV, et al. - Since high-sensitivity cardiac troponin testing and grouping patients with myocardial injury based on pathogenesis has been advised by the Universal Definition of Myocardial Infarction, but there is a lack of proper understanding of the clinical implications of executing this guideline, so, researchers undertook this stepped-wedge cluster randomized controlled trial, wherein, they implemented a high-sensitivity cardiac troponin assay as well as the suggestions of the Universal Definition among 48,282 consecutive patients with suspected acute coronary syndrome. As a result of the implementation, an increase was evident in the diagnosis of type 1 myocardial infarction, type 2 myocardial infarction, and acute and chronic myocardial injury, by 11% (510/4471), 22% (205/916), 36% (443/1233) and 43% (389/898), respectively. Identification of cases at high risk of cardiovascular and noncardiovascular events was enabled by the implementation of high-sensitivity cardiac troponin assays and the recommendations of the Universal Definition of Myocardial Infarction, but no link of such an implementation with consistent increases in treatment or improved outcomes was identified. There is an urgent need for trials of secondary prevention in order to know if this risk is modifiable in patients without type 1 myocardial infarction.