Key result
Perioperative myocardial infarction occurred in 35.5% of patients undergoing surgery for acute hip fracture, with old age, prior revascularization, and heart failure as independent predictors.
Cohort (n=200)
Perioperative myocardial infarctions are highly prevalent (35.5%) but often asymptomatic and clinically unrecognized in elderly patients undergoing hip fracture surgery.
May warrant closer troponin surveillance in elderly hip fracture patients with HF or prior revascularization; leaves open whether interventions alter outcomes.
BACKGROUND: The aim of this prospective cohort study was to assess the incidence and characteristics of acute myocardial infarction in patients undergoing surgery for acute hip fracture. METHODS: A consecutive cohort of patients (n = 200, 68 men) referred to acute surgical correction of hip fracture was studied. Troponin T (TnT) measurements and electrocardiographic (ECG) recordings were performed at admission, before operation, and on the first and 2nd postoperative days, which were used for diagnosis. RESULTS: The age of the patients ranged from 32 to 98 years (mean, 80.8 years), and 65 patients had a history of coronary artery disease. A significant rise in TnT as a sign of myocardial infarction was observed in 71 patients (35.5%), and 25 of them had a TnT elevation exceeding five times the upper normal limit. TnT elevation was observed in 36 patients (51%) already before surgery. Seven patients (10%) had ST elevation myocardial infarction, 23 patients (32%) had new ST depressions, and 21 patients (30%) had no new ST segment changes in the serial electrocardiographic recordings. In 40 patients (56%), the perioperative myocardial infarction was the first manifestation of coronary artery disease. Multivariate logistic regression revealed that old age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10; p = 0.002), earlier revascularization (OR, 3.29; 95% CI 1.12-9.73; p = 0.03), and heart failure (OR, 2.42; 95% CI 1.04-5.61; p = 0.04) were independent predictors of TnT elevation. Majority of myocardial infarctions were asymptomatic or unrecognized. Evidence-based medications of myocardial infarction were seldom started and cardiologist was consulted in 12 patients (16.9%). CONCLUSION: Patients with hip fracture often develop asymptomatic and clinically unrecognized perioperative myocardial infarctions. Earlier diagnosis and appropriate treatment of cardiac infarction may improve survival of hip fracture patients. LEVEL OF EVIDENCE: Epidemiologic study, level III.
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Hietala et al. (2013) conducted a cohort in Acute hip fracture (n=200). Surgery for acute hip fracture was evaluated on Incidence of acute myocardial infarction (significant rise in Troponin T). Perioperative myocardial infarction occurred in 35.5% of patients undergoing surgery for acute hip fracture, with old age, prior revascularization, and heart failure as independent predictors.
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