Troponin T is a strong predictor of mortality in hip fracture patients

Abstract

Background: The aim of this prospective cohort study was to assess the prognosis of acute myocardial infarction in a series of consecutive hip fracture patients treated surgically. Methods: A consecutive cohort of patients (n=200, 68 men) referred to un-elective surgical correction of hip fracture was studied. In addition to clinical evaluation, troponin T (TnT), and ECG were assessed on admission, before operation and on 1st and 2nd post-operative days. The patients were followed at 30 days, 1 year and 2 years. Results: The age of the patients ranged from 32 to 98 years (mean age 80.8 years). 65 patients (33%) had a history of coronary artery disease. And 28 (14%) suffered from heart failure. A significant rise in TnT as a sign of myocardial infarction was observed in 71 patients (36%), and 36 (51%) of them had an elevation of TnT already before surgery. 23 (32%) patients had an elevated level of TnT already on admission to hospital, and 35 (49%) developed a TnT elevation postoperatively. Majority of patients with elevated TnT level were asymptomatic. TnT elevations were more common in men, elderly patients, and patients with a history of cardiovascular diseases. The 30-day mortality was 17% in patients with a TnT elevation and 5% in patients with no TnT elevation (p = 0,008). The 1-year mortality was 38% in patients with a TnT elevation and 24% in patients with no TnT elevation (p < 0,05). The 2-year mortality was 48% in patients with a TnT elevation and 31% in patients with no TnT elevation (p=0,01). Elevated TnT level on admission was a strong predictor of mortality at both 1-month, 6/23 (26.1%) vs. 11/171 (6.4%) (p < 0.007), and 1-year, 11/23 (47.8%) vs. 45/171 (26.3%) (p < 0.048). Conclucions: Patients with a hip fracture often develop asymptomatic or clinically unrecognized perioperative myocardial infarctions. Elevated level of TnT in hip fracture patients is a strong predictor of mortality at 1-month, 1-year and 2-years. Earlier diagnosis and appropriate treatment of cardiac infarction might improve survival of hip fracture.