Clinical laboratory reports should indicate whether sig- nificant changes in cardiac troponin values for the par- ticular assay have occurred. Absolute changes in nanograms per liter of high-sensitivity cardiac troponin T levels appear to have a significantly higher diagnostic accuracy for AMI than relative changes and may distinguish AMI from other causes of high-sensitivity cardiac troponin T elevations.71 This has also been suggested for some Troponins are elevated in MI as early as and many medical centers obtain troponins at 3 hours. Depending on the assay, values may not become abnormal for up to 12 hours. In the vast majority of patients with symptoms suggestive ofACS, MI can be excluded or confirmed within 6 hours, because very few patients present immediately after symptom onset. In high-risk patients, mea- surements after 6 hours may be required to identify ACS. Solitary elevations of troponin cannot be assumed to be due to MI, because troponin elevations can be due to tachyarrhyth- mia, hypotension or hypertension, cardiac trauma, acute HF, myocarditis and pericarditis, acute pulmonary thromboembolic disease, and severe noncardiac conditions such as sepsis, burns, respiratory failure, acute neurological diseases, and drug toxicity (including cancer chemotherapy). Chronic elevations can result from structural cardiac abnormalities such as LV hypertrophy or ventricular dilatation and are also common in patients with renal Patients with end-stage renal disease and no clini- cal evidence of ACS frequently have elevations of cardiac tropo- With conventional assays, this is more common with cardiac troponin T than with cardiac troponin I.180 In the diagnosis of NSTEMI, cardiac troponin values must manifest an acute pat- tern consistent with the clinical events, including ischemic symp- toms and electrocardiographic changes. Troponin elevations may persist for up to 14 days or occasionally longer. 