Isolated cardiac troponin rise does not modify the prognosis in elderly patients with hip fracture
Hélène Vallet1, Alice Breining, Yannick Le Manach
1Sorbonne Universités UPMC Univ Paris 06, DHU FAST UMRS INSERM 1166, IHU ICAN UMRS INSERM 1158 Department of Geriatry Department of Anesthesiology and Critical Care Department of Emergency Medicine and Surgery Department of Orthopedic Surgery and Trauma Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Population Health Research Institute, Perioperative Medicine and Surgical Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Canada Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine Centre National de la Recherche Scientifique (CNRS), Paris, France.
Insights
Isolated troponin rise (ITR) in elderly hip fracture patients did not significantly increase 6-month mortality or rehospitalization. Acute coronary syndrome (ACS) was associated with worse outcomes, highlighting the need for differentiated risk assessment.
Area of Science:
- Cardiology
- Geriatric Medicine
- Orthopedic Surgery
Background:
- Perioperative myocardial infarction is a serious complication after noncardiac surgery.
- Even an isolated troponin rise (ITR) can be linked to significant mortality.
- Assessing the prognostic value of ITR in elderly hip fracture patients is crucial.
Purpose of the Study:
- To evaluate the prognostic significance of isolated troponin rise (ITR) in elderly patients undergoing hip fracture surgery.
- To compare outcomes between patients with ITR, acute coronary syndrome (ACS), and a control group.
Main Methods:
- A cohort study included 312 elderly patients (mean age 85) undergoing hip fracture surgery.
- Patients were categorized into Control, ITR, and ACS groups based on cardiac troponin I levels.
- Primary endpoint was a composite of 6-month mortality and/or re-hospitalization; secondary endpoints included mortality and functional outcomes.
Main Results:
- No significant difference in postoperative complications between ITR and Control groups.
- ACS group showed higher rates of atrial fibrillation, heart failure, hemorrhage, and ICU admission.
- Six-month mortality/re-hospitalization was not significantly increased in the ITR group (28%) compared to Control (26%).
- ACS group had significantly increased 6-month mortality/re-hospitalization (44%) versus Control (26%).
- ITR was not linked to increased institutionalization or impaired walking ability at 6 months.
Conclusions:
- In elderly patients with hip fractures, isolated troponin rise (ITR) is not associated with increased 6-month mortality or re-hospitalization.
- Acute coronary syndrome (ACS) in this population is linked to significantly worse outcomes.
- Risk stratification should differentiate between ITR and ACS following hip fracture surgery.
Abstract:
Perioperative myocardial infarction remains a life-threatening complication in noncardiac surgery and even an isolated troponin rise (ITR) is associated with significant mortality. Our aim was to assess the prognostic value of ITR in elderly patients with hip fracture.In this cohort study, all patients admitted between 2009 and 2013 in our dedicated geriatric postoperative unit after hip fracture surgery with a cardiac troponin I determination were included and divided into Control, ITR, and acute coronary syndrome (ACS) groups. The primary end point was a composite criteria defined as 6-month mortality and/or re-hospitalization. Secondary end points included 30-day mortality, 6-month mortality, and 6-month functional outcome.Three hundred twelve patients were (age 85 ± 7 years) divided into Control (n = 217), ITR (n = 50), and ACS (n = 45) groups. There was no significant difference for any postoperative complications between ITR and Control groups. In contrast, atrial fibrillation, acute heart failure, hemorrhage, and ICU admission were significantly more frequent in the ACS group. Compared to the Control group, 6-month mortality and/or rehospitalization was not significantly modified in the ITR group (26% vs. 28%, P = 0.84, 95% confidence interval [CI] of the difference -13%-14%), whereas it was increased in the ACS group (44% vs. 28%, P = 0.02, 95% CI of the difference 2%-32%). ITR was not associated with a higher risk of new institutionalization or impaired walking ability at 6 months, in contrast to ACS group.In elderly patients with hip fracture, ITR was not associated with a significant increase in death and/or rehospitalization within 6 months.
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