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Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery . 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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Intervention_Surgical
acute surgical correction of hip fracture
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Intervention_Physical
Troponin T ( TnT ) measurements
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Intervention_Physical
electrocardiographic ( ECG ) recordings
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Outcome_Physical
Perioperative myocardial infarctions
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Outcome_Physical
rise in TnT
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Outcome_Physical
myocardial infarction
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Outcome_Physical
TnT elevation
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Outcome_Physical
TnT elevation
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Outcome_Physical
ST elevation myocardial infarction
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Outcome_Physical
new ST depressions
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Outcome_Physical
Majority of myocardial infarctions
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Outcome_Other
Evidence-based medications
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Participant_Condition
undergoing hip fracture surgery
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Participant_Condition
surgery for acute hip fracture
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Participant_Condition
acute surgical correction of hip fracture
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Participant_Age
age of the patients ranged from 32 to 98 years ( mean , 80.8 years
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Participant_Condition
history of coronary artery disease