Acute exacerbations are the important reasons for hospitalization and death in chronic obstructive pulmonary disease (COPD) patients. We aimed to evaluate the relationship between serum concentrations of cardiac troponin I (cTnI) and the outcome of COPD patients visiting the emergency department with acute exacerbation of COPD (AECOPD). In this study, we included 90 AECOPD patients between October 2018 and October 2019. Serum cTnI was measured during the first 24 and 48 hours after admission. Patients were categorized into two groups positive cTnI values (≥0.3 ng/dl) and negative cTnI (<0.3 ng/dl). The outcomes of patients were compared between the two groups. Patients in Positive cTnI group in the first 24 hours and 48 hours compared to patients in negative group had significantly higher rate of in-hospital [(66.7% vs. 3.7%, P<0.001) and (50.0% vs. 3.8%, P<0.001), respectively)] and 30-day mortality rates [(88.9% vs. 3.3%, P<0.001) and (66.7% vs. 5.1%, P<0.001), respectively)]. The number of cases requiring intubation [(100% vs. 12.3%, P<0.001) and (75.0% vs. 12.8%, P<0.001), respectively)] and cardiopulmonary resuscitation (CPR) [(100.0% vs. 5.5%, P<0.05) and (100.0% vs. 5.5%, P<0.001), respectively)] as well as the duration of intensive care unit (ICU) stay [(37.00±14.61 vs 9.83±4.93 days, P<0.001) and (37.00±14.61 vs 9.83±4.93 days, P<0.001), respectively)] were also higher in cTnI positive patients. Increased cTnI during AECOPD is associated with higher rates of CPR, need for mechanical ventilation and in-hospital, short-term mortalities, and a longer ICU stay.