Related Experiment Videos
Preoperative High-Sensitivity Troponin and Risk of In-Hospital Mortality and Cardiac Events after Hip Fracture
Aly S Toure1, Kenechukwu Okafor1, Bryan Medilien1
1Emory University School of Medicine, Atlanta, GA, USA.
Insights
Preoperative high-sensitivity cardiac troponin elevation independently predicts in-hospital cardiac events and mortality in hip fracture patients. Levels over 100 ng/L indicate the highest risk, regardless of surgical delay.
Area of Science:
- Cardiology
- Geriatric Medicine
- Trauma Surgery
Background:
- Hip fracture surgery poses significant risks for cardiac events and mortality.
- Preoperative cardiac risk assessment is crucial for optimizing patient outcomes.
- High-sensitivity cardiac troponin (hs-cTn) is a sensitive biomarker for myocardial injury.
Purpose of the Study:
- To determine if elevated preoperative hs-cTn predicts in-hospital cardiac events and mortality after hip fracture surgery.
- To investigate whether surgical delay influences the relationship between hs-cTn and adverse outcomes.
- To identify specific hs-cTn thresholds associated with increased risk.
Main Methods:
- Retrospective cohort study of adult patients undergoing hip fracture surgery with preoperative hs-cTn measurements.
- Patients were categorized by hs-cTn levels: normal (<30 ng/L), elevated (30-100 ng/L), and significantly elevated (>100 ng/L).
- Surgical delay was analyzed in categories: <24 hours, 24-48 hours, and >48 hours.
Main Results:
- A total of 510 patients were included; 6.9% experienced the composite outcome of cardiac event or mortality.
- Significantly elevated hs-cTn (>100 ng/L) was associated with a 35.7% composite outcome rate (p < 0.001).
- Adjusted models showed elevated hs-cTn (OR 4.4) and significantly elevated hs-cTn (OR 16.1) were independently associated with increased odds of the composite outcome.
Conclusions:
- Preoperative hs-cTn elevation is an independent predictor of in-hospital cardiac events and mortality following hip fracture surgery.
- hs-cTn levels >100 ng/L identify patients at the highest risk, irrespective of surgical delay.
- These findings support the use of hs-cTn for risk stratification in hip fracture patients.
Objectives:
To evaluate whether preoperative hs-cTn elevation predicted in-hospital cardiac events and mortality following hip fracture surgery, and whether surgical delay modified this relationship.
Design:
Retrospective cohort study.
Setting:
Single Level 1 trauma center in the United States.
Patient Selection Criteria:
Adult patients who underwent hip fracture surgery between January 1, 2020, and December 31, 2024, and had a preoperative high-sensitivity cardiac troponin measurement as part of routine perioperative assessment were included.
Outcome Measures And Comparisons:
The primary outcome was a composite of in-hospital cardiac event or mortality. Secondary outcomes were in-hospital mortality and in-hospital cardiac events analyzed separately. Outcomes were compared across preoperative troponin categories defined as normal (<30 ng/L), elevated (30-100 ng/L), and significantly elevated (>100 ng/L), as well as across surgical delay categories defined as <24 hours, 24-48 hours, and >48 hours.
Results:
A total of 510 patients were included. Mean age was 76.3 ± 14.1 years, and 291 patients (57.1%) were female. Preoperative troponin was normal in 424 patients (83.1%), elevated in 58 patients (11.4%), and significantly elevated in 28 patients (5.5%). Thirty-five patients (6.9%) experienced the composite outcome. The composite outcome occurred in 19 of 424 patients (4.5%) with normal troponin, 6 of 58 patients (10.3%) with elevated troponin, and 10 of 28 patients (35.7%) with significantly elevated troponin (p < 0.001). Mortality occurred in 8 of 424 patients (1.9%), 2 of 58 patients (3.4%), and 3 of 28 patients (10.7%), respectively (p = 0.015). Cardiac events occurred in 13 of 424 patients (3.1%), 4 of 58 patients (6.9%), and 9 of 28 patients (32.1%), respectively (p < 0.001). In adjusted models, elevated high-sensitivity cardiac troponin was associated with increased odds of the composite outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-17.9, p = 0.038), and significantly elevated troponin was associated with higher odds of the composite outcome (OR 16.1, 95% CI 3.6-72.4, p < 0.001). Higher American Society of Anesthesiologists class independently predicted the composite outcome and mortality, and longer length of stay was associated with cardiac events.
Conclusions:
Preoperative high-sensitivity cardiac troponin elevation was independently associated with in-hospital cardiac events and mortality after hip fracture surgery. Troponin levels greater than 100 ng/L identified patients at highest risk, independent of surgical delay.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Cardiac Catheterization IV: Nursing Management
01:22Aneurysm IV: Nursing Management