Isolated cardiac troponin rise does not modify the prognosis in elderly patients with hip fracture

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.

Retrospective Evaluation of a Restrictive Transfusion Strategy in Older Adults with Hip Fracture

“…Nevertheless, all participants were informed of (and given the option to refuse) inclusion in the database, which was declared to the French national data privacy authority (Commission Nationale de l'Informatique et des Libertés, Paris, France). Some participants had been included in previous studies . The UPOG care pathway methodology has been described elsewhere …”

“…Some participants had been included in previous studies . The UPOG care pathway methodology has been described elsewhere …”

“…All complications during the hospitalization were recorded, including our primary endpoint (acute cardiovascular complications). The endpoint was defined as a composite: acute heart failure, coronary syndrome, atrial fibrillation, or stroke during hospitalization in the UPOG. Diagnosis of acute heart failure was based on clinical evidence according to hemodynamic, clinical, biological, and radiological findings if needed.…”

“…Agreement between experts was 99% (kappa=0.991). Participants were studied until death or 6 months after admission for living status as previously described …”

Innovations in management of cardiac disease: drugs, treatment strategies and technology

“…82 In non-cardiac, non-vascular surgery, a systematic review based on 11 studies with 2123 patients has shown odds ratios for 30-day and 1 yr mortality of, respectively, 3.53 (95% CI 2.21-5.62) and 2.53 (95% CI 1.20-5.36), and for major adverse cardiac events of 5.92 (95% CI 1.67-20.96) at 30day and 3.00 (95% CI 1.43-6.29) at 1 yr. 83 Age may play a role in the association between elevated troponins and outcome as a relatively small study in elderly patients with hip fracture has shown that isolated troponin I elevation was not associated with adverse outcome while a clinical acute coronary syndrome was. 84…”