Troponin Tests in Patients Admitted to Internal Medicine Departments Without an Acute Coronary Syndrome-Less Is More.

Introduction: The study aimed to determine the frequency and factors associated with elevated troponin test results and whether an elevated test result provides an independent incremental increase in in-hospital mortality and affects patient care.

Methods: We selected consecutive patients admitted to 3 internal medicine departments in a regional hospital in 2020-2021 after excluding those with chest pain or ischemic electrocardiographic changes. The outcome variables were in-hospital mortality, elevated troponin test results, repeat testing, and changes in patient care. Other variables included male sex, age, nursing patient assessments, laboratory tests, and discharge diagnosis.

Results: There were 10,483 patients aged 73 ± 19 years, 51.1% (n = 5359) were female, and troponin was ordered in 16.2%. Elevated values above the reference range (>14 ng/L), ≥20 ng/L, and ≥50 ng/L were found in 70.6% (1247/1767), 56.1% (n = 992) and 22.4% (n = 396), respectively. Older age, male sex, poor nutritional and mental status, being bedridden, and abnormal basic laboratory tests predicted troponin values of ≥50 ng/L with a c-statistic of 0.857 (0.833-0.867). In the model predicting in-hospital mortality, adding an elevated troponin test did not significantly change the deciles of risk or c-statistics (0.89 and 0.91, respectively). Elevated troponin test values were associated with repeat testing and cardiology consultations. Three patients had coronary arteriograms without a percutaneous coronary intervention.

Conclusion: In patients hospitalized without chest pain or ischemic electrocardiographic changes, elevated troponin tests are common, do not provide an incremental increase in in-hospital mortality risk, and negatively affect patient care.