Troponin rise indicates myocardial cell injury. However, elevated values of troponin are not always consequence of infarction or ischemia. In this paper, aim was to elucidate diverse etiologies of elevated troponin in patients with normal coronary angiography. At KBC Zagreb in 2014 there was 976 patients identified from catheterization database who underwent coronary angiography due to suspicion of acute coronary syndrome (ACS). We identified 30 (3.1%) patients who had alternative cause for myocyte injury other than coronary artery disease (CAD), meaning that there was less than 30 % coronary arterial luminal stenosis. The elevation of cardiac troponin T (cTnT) in patients with normal coronary angiography was attributed to diverse etiologies, including hypertensive crisis, Takotsubo syndrome, severe aortic stenosis, atrial fibrillation (AF), chronic obstructive pulmonary disease (COPD) exacerbation, advanced heart failure, hypertensive cardiomyopathy, acute pulmonary embolism, malignant disease progression, and cardiogenic shock. Apart from ACS, cTnT could be elevated in a number of different conditions, which should be considered according to clinical presentation, different diagnostic procedure, and still could reflect myonecrosis, even in the absence of significant angiographic CAD.