Causes of Increased Cardiac Troponin I Levels in Hospitalized Patients Without Coronary Artery Diseas

We reviewed the charts of 3,979 hospitalized patients who had troponin I levels measured to determine the causes of increased cardiac troponin I levels in patients without coronary artery disease (CAD) and their inhospital mortality. An increased troponin I level was >0.4 ng/ml. Troponin I levels were increased in 581 of 3,979 hospitalized patients (14.6%) and in 199 of 3,398 patients (5.9%) without CAD. The 199 patients included 122 men and 77 women, mean age 79 years. Of the 199 patients with increased troponin I levels and no CAD, 59 (29.6%) had sepsis, 49 (24.6%) had congestive heart failure, 22 (11%) had a stroke, 18 (9%) had hypotension, 13 (6.5%) had respiratory failure, 13 (6.5%) had renal failure, 13 (6.5%) had gastrointestinal bleeding, 9 (4.5%) had ventricular or supraventricular tachyarrhythmias, and 3 (1.5%) had pulmonary embolism. Of these 199 patients, 46 (23.1%) died during hospitalization. The mean peak troponin I levels were 6.53 ± 15.1 ng/ml in the 46 patients who died during hospitalization versus 3.27 ± 5.36 ng/ml in the 153 patients who were discharged from the hospital (p not significant). In conclusion, numerous causes other than CAD may cause increased cardiac troponin I levels in hospitalized patients. The in-hospital mortality is high in these patients.