Troponin Testing in Patients Without Chest Pain or Electrocardiographic Ischemic Changes

Background Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes. Objectives The objective of this study was to determine clinical utility, and downstream testing in patients with elevated troponin values but without chest pain or electrocardiographic changes. Methods We selected all patients aged 30-100 years hospitalized in cardiology and internal medicine departments from July 1, 2013 until July 31, 2016. We chose a subgroup of 723 consecutive subjects with elevated troponin values for chart review to determine the proportion of patients without chest pain or ischemic electrocardiographic changes, and resultant differential treatment and downstream testing. Clinical utility was defined as coronary artery interventions or treatment of life-threatening arrhythmias. Results Troponin measurements were sent in 52.5% of all hospitalized patients (16,519/31,448), and were elevated in 29.9% (4938/16,519). Nearly two-thirds of the patients reviewed had neither chest pain nor ischemic electrocardiographic changes (63.3% [458/723]), and the elevated troponin values did not result in coronary artery interventions or treatment of life-threatening arrhythmias. The elevated troponin values were the sole reason for hospitalization in 2.0% (n = 9), for cardiac monitoring in 6.1% (n = 28), for cardiac consultations in 11.1% (n = 51), and for left heart catheterization in 0.7% (n = 3) of the patients. Conclusion Most of the elevated troponin test results were in patients without chest pain or ischemic electrocardiographic changes, had no clinical utility, and resulted in downstream testing.