Key result
Perioperative myocardial injury with peak troponin ≥1 µg/L was associated with significantly higher in-hospital mortality compared to no injury (HR 2.28; 95% CI 1.72-3.02; p<0.0001).
Why the study?
Cardiovascular complications during non-cardiac surgery are linked to worse outcomes, but the incidence and mortality impact of perioperative myocardial infarction or injury in hip fracture surgery required assessment.
Does perioperative myocardial injury/infarction increase in-hospital mortality in elderly patients undergoing hip fracture surgery?
Cohort (n=1,854)
Does perioperative myocardial injury/infarction increase in-hospital mortality in elderly patients undergoing hip fracture surgery?
Hazard Ratio: 2.28 (95% CI 1.72–3.02)
p-value: p=<0.0001
Perioperative myocardial injury, as indicated by elevated troponin levels, is strongly associated with increased in-hospital mortality in elderly patients undergoing hip fracture surgery, regardless of ischemic ECG changes.
Elevated perioperative troponin may aid risk stratification in elderly hip fracture patients; leaves open whether targeted interventions improve survival.
Cardiovascular complications in patients undergoing non-cardiac surgery are associated with longer hospital stays and higher in-hospital mortality. The aim of this study was to assess the incidence of in-hospital myocardial infarction and/or myocardial injury in patients undergoing hip fracture surgery and their association with mortality. Moreover, we evaluated the prognostic value of troponin increase stratified on the basis of peak troponin value. The electronic records of 1970 consecutive hip fracture patients were reviewed. Patients <70 years, those with myocardial infarction <30 days, and those with sepsis or active cancer were excluded from the study. Troponin and ECG were obtained at admission and then at 12, 24, and 48 h after surgery. Echocardiography was made before and within 48 h after surgery. Myocardial injury was defined by peak troponin I levels > 99th percentile. A total of 1854 patients were included. An elevated troponin concentration was observed in 754 (40.7%) patients in the study population. Evidence of myocardial ischemia, fulfilling diagnosis of myocardial infarction, was found in 433 (57%). ECG and echo abnormalities were more frequent in patients with higher troponin values; however, mortality did not differ between patients with and without evidence of ischemia. Peak troponin was between 0.1 and 1 µg/L in 593 (30.3%). A total of 191 (10%) had peak troponin I ≥ 1 µg/L, and 98 died in hospital (5%). Mortality was significantly higher in both groups with troponin increase (HR = 1.37, 95% CI 1.1–1.7, p < 0.001 for peak troponin I between 0.1 and 1 µg/L; HR = 2.28, 95% CI 1.72–3.02, p < 0.0001 for peak troponin ≥1 µg/L) in comparison to patients without myocardial injury. Male gender, history of coronary heart disease, heart failure, and chronic kidney disease were also associated with in-hospital mortality. Myocardial injury/infarction is associated with increased mortality after hip fracture surgery. Elevated troponin values, but not ischemic changes, are related to early worse outcome.
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Rostagno et al. (2020) conducted a cohort in Hip fracture surgery (n=1,854). Perioperative myocardial injury (elevated troponin) vs. No myocardial injury was evaluated on In-hospital mortality (HR 2.28, 95% CI 1.72-3.02, p=<0.0001). Perioperative myocardial injury with peak troponin ≥1 µg/L was associated with significantly higher in-hospital mortality compared to no injury (HR 2.28; 95% CI 1.72-3.02; p<0.0001).
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