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Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery

Hietala, Pauliina MD; Strandberg, Marjatta MD, PhD; Strandberg, Niko MD; Gullichsen, Eero MD, PhD; Airaksinen, K.E. Juhani MD, PhD

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 1087–1091
doi: 10.1097/TA.0b013e3182827322
Original Articles

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

From the Division of Cardiology (P.H., M.S., K.E.J.A.), Department of Internal Medicine; and Department of Orthopaedics and Traumatology (N.S., E.G.), Turku University Hospital, Turku, Finland.

Submitted: September 27, 2012; Revised: October 31, 2012; Accepted: October 31,2012.

This study was supported by unrestricted grants from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland.

Address for reprints: K.E. Juhani Airaksinen, MD, PhD, Department of Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland; email: juhani.airaksinen@tyks.fi.

© 2013 Lippincott Williams & Wilkins, Inc.