title: Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery.
abstract: BACKGROUND
  Patterns of clinical symptoms and outcomes of perioperative myocardial infarction (PMI) in elderly patients after hip fracture repair surgery are not well defined.
  
  
  METHODS
  A retrospective 1:2 case-control study in a cohort of 1212 elderly patients undergoing hip fracture surgery from 1988 to 2002 in Olmsted County, Minnesota.
  
  
  RESULTS
  The mean age was 85.3 ± 7.4 years; 76% female. PMI occurred in 167 (13.8%) patients within 7 days, of which 153 (92%) occurred in first 48 hours; 75% of patients were asymptomatic. Among patients with PMI, in-hospital mortality was 14.4%, 30-day mortality was 29 (17.4%), and 1-year mortality was 66 (39.5%). PMI was associated with a higher inpatient mortality rate (odds ratio [OR], 15.1; confidence interval [CI], 4.6-48.8), 30-day mortality (hazard ratio [HR], 4.3; CI, 2.1-8.9), and 1-year mortality (HR, 1.9; CI, 1.4-2.7).
  
  
  CONCLUSIONS
  Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI-associated mortality.
authors.affiliation: Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. gupta.bhanu@mayo.edu
authors.forename: Bhanu P
authors.initials: BP
authors.lastname: Gupta
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Huddleston
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Kirkland
authors.forename: Paul M
authors.initials: PM
authors.lastname: Huddleston
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Gullerud
authors.forename: M Caroline
authors.initials: MC
authors.lastname: Burton
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: R Scott
authors.initials: RS
authors.lastname: Wright
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016022:Case-Control Studies; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form