Key result
Silent intraoperative ST elevation progresses to ventricular fibrillation during hip hemiarthroplasty requiring emergency PCI.
Why the study?
Perioperative myocardial infarction may occur without typical ischemic symptoms in elderly patients undergoing hip fracture repair, complicating diagnosis and management.
Case Report (n=1)
No
This case report highlights the vulnerability of elderly patients with prior coronary stents to silent intraoperative myocardial infarction during non-cardiac surgery, demonstrating the utility of continuous ECG monitoring and rapid multidisciplinary rescue.
Silent ST elevation may signal intraoperative stent thrombosis in elderly noncardiac surgery patients; this case leaves open whether routine ECG monitoring improves outcomes.
Perioperative myocardial infarction may occur without typical ischemic symptoms in elderly patients undergoing hip fracture repair. We describe the case of an 86-year-old woman with hypertension, coronary artery disease, and prior right coronary artery stenting who underwent right hip hemiarthroplasty under spinal anesthesia after clopidogrel had been withheld for one week. Continuous electrocardiographic monitoring showed progressive ST-segment elevation first recognized by the anesthesia nurse, who verified the finding and immediately informed the anesthesiology team. ST-segment elevation preceded a decline in heart rate and blood pressure and was followed by ventricular fibrillation during emergency transfer for coronary angiography. Repeated cardiopulmonary resuscitation and 200-J defibrillation produced transient rhythm recovery, with recurrent ventricular fibrillation until coronary reperfusion. Angiography showed acute right coronary artery occlusion at the previous stent site with thrombus; balloon angioplasty, intracoronary tirofiban, and implantation of a 2.75 × 29 mm drug-eluting stent restored TIMI grade 3 flow, with approximately 30% residual stenosis. Troponin T was >50 ng/mL on postoperative day 1, 4056 ng/mL on day 5, and 900 ng/mL on day 9; no major bleeding, transfusion, or neurological complications were documented. The patient ambulated before discharge on postoperative day 15. This case illustrates a descriptive temporal sequence in which progressive monitor-detected ST-segment changes preceded hemodynamic deterioration and subsequent ventricular fibrillation, followed by nursing verification, escalation, and multidisciplinary rescue; it does not establish that any specific monitoring or escalation strategy altered the outcome. Because this is a single case, the chronology described is observational and does not permit causal inference regarding the outcome.
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Wang et al. (2026) conducted a case report in Hip fracture and coronary artery disease (n=1). Hip hemiarthroplasty with prior clopidogrel interruption was evaluated on Clinical course of intraoperative ST-segment elevation and hemodynamic deterioration. An 86-year-old woman with a prior coronary stent developed silent intraoperative ST-segment elevation progressing to ventricular fibrillation during hip hemiarthroplasty, requiring emergency PCI.
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