False-Positive High-Sensitivity Troponin I in Clinical Practice

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) is essential for diagnosing myocardial infarction, however, false-positive results can significantly influence clinical management. CASE SERIES SUMMARY: Over 13 months, 11 patients at a regional Queensland hospital showed elevated hs-cTnI without supportive clinical or imaging evidence of myocardial infarction. Validation using i-STAT point-of-care testing and formal interference studies confirmed all results as false positives. DISCUSSION: In a setting without onsite cardiac services, analytical accuracy is critical. False-positive troponin results may trigger incorrect diagnoses, anticoagulation or antiplatelet therapy, interfacility transfers, invasive procedures, hospitalization, and heightened patient anxiety, all with significant implications for patient safety, resource use, and health care costs. TAKE-HOME MESSAGES: False-positive hs-cTnI results continue to represent a significant diagnostic challenge in the era of advanced analytical assays. Clinicians should remain vigilant when laboratory findings conflict with clinical presentations. Targeted interference investigations and confirmation through alternative assay platforms can mitigate organizational and patient risk.