Résumé : Chest pain is a common complaint in the Emergency department (ED). Identifying the various causes of this complaint is a difficult task for emergency physicians, especially when the three WHO criteria that define a myocardial infarction (typical pain, electrocardiographical change and elevation of a cardiac marker) are not present. The measurement of a biological tracer, particularly the cardiac troponin I (cTnI) occupies a key position in the process of reaching a decision. When clinical and biological features are discordant, the meaning of cTnI elevation is controversial since it may not always be related to myocardial ischemia or a purely cardiac event. In order to better understand the interpretation of a high cTnI level in the ED, a study has been conducted in the ED of three university hospitals. cTnI level was determined in 163 patients who presented with chest pain (91) or dyspnea (40) and in those who were admitted for trauma (12) or pyrexia (20). An electrocardiogram and laboratory tests of cardiac markers were obtained in all. Troponin level was increased in 33 patients; 19 of them had a cardiac disease and 14 had a non-cardiac disease, 12 of which were infections. The 19 cardiac patients showed a significantly higher level of troponin than the other 14 who were free of cardiac disease. Elevated troponin can be explained by analytic interferences related to the sample or by minimal myocardial injuries. However, the present cutoff is lower than those recently recommended, creating a certain number of false-positive results.