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

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.

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.

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.

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.