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In the context of a patient presenting with substernal chest pain and ST segment elevation, the most useful data for acute management is Troponin I levels. Troponin is a cardiac biomarker that indicates myocardial injury or infarction. Elevated levels of Troponin I suggest that the heart muscle is damaged, which is critical information for guiding immediate treatment decisions, such as the need for urgent reperfusion therapy (e.g., percutaneous coronary intervention or thrombolysis).

Troponin testing provides timely information that facilitates the diagnosis of acute coronary syndrome, particularly ST-elevation myocardial infarction (STEMI). The results can aid clinicians not only in confirming the diagnosis but also in assessing the extent of myocardial damage, which is vital for determining treatment pathways and interventions aimed at re-establishing blood flow to the heart.

While serum electrolytes can be important to monitor for potential complications such as arrhythmias, coagulation studies provide insight into the clotting status, and lipid profiles are more relevant for long-term risk assessment and management, none of these options provide the immediate data required for acute management as effectively as Troponin I levels do in this scenario.