Troponin elevations convey prognostic assessment beyond that of clinical information, the initial ECG, and the predischarge In addition, troponin elevations may provide infor- mationtodirecttherapy.Patientswithcardiactroponinelevations Table 5. Summary of Recommendations for Cardiac Biomarkers and the Universal Definition of MI Recommendations COR LOE References Diagnosis Measure cardiac-specific troponin (troponin I or T) at presentation and 3 6 h after symptom onset in all patients with suspected ACS to identify pattern of values Obtain additional troponin levels beyond 6 h in patients with initial normal serial troponins with electrocardiographic changes and/or intermediate/high risk clinical features Consider time of presentation the time of onset with ambiguous symptom onset for assessing troponin values With contemporary troponin assays, CK-MB and myoglobin are not useful for diagnosis of ACS III: No Benefit A 158 164 Prognosis Troponin elevations are useful for short- and long-term prognosis I B 71, 73, 165, 166 Remeasurement of troponin value once on d 3 or 4 in patients with MI may be reasonable as an index of infarct size and dynamics of necrosis BNP may be reasonable for additional prognostic information IIb B 87, 88, 167 171 ACS indicates acute coronary syndromes; BNP, B-type natriuretic peptide; CK-MB, creatine kinase myocardial isoenzyme; COR, Class of Recommendation; LOE, Level of Evidence; and MI, myocardial infarction. Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e359 are at high risk and benefit from intensive management and early High risk is optimally defined by the changing pattern as described in Section 3.4.3. Cardiac troponin elevations correlate with estimation of infarct size and risk of death; persistent elevation 72 to 96 hours after symptom onset may afford relevant information in this regard.164 Elevations of cardiac troponin can occur for multiple reasons other than MI. 