Our study aims to test the hypothesis that troponin positive patients have more severe coronary artery disease (CAD). It also aims to determine the correlation between troponin elevation and myocardial tissue perfusion and assess the incidence of adverse cardiac events. Our data shows that troponin elevation was linked to morphological complexity of the target lesion and to visibility of thrombus formation. Furthermore, troponin elevation was associated with impaired tissue level perfusion, which in turn was translated into a higher risk of morbidity and mortality on 1 year follow-up.