title: 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.
authors.affiliation: Sorbonne Universités UPMC Univ Paris 06, DHU FAST UMRS INSERM 1166, IHU ICAN UMRS INSERM 1158 Department of Geriatry Department of Anesthesiology and Critical Care Department of Emergency Medicine and Surgery Department of Orthopedic Surgery and Trauma Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Population Health Research Institute, Perioperative Medicine and Surgical Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Canada Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine Centre National de la Recherche Scientifique (CNRS), Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Vallet
authors.forename: Alice
authors.initials: A
authors.lastname: Breining
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Manach
authors.forename: Judith
authors.initials: J
authors.lastname: Cohen-Bittan
authors.forename: Anthony
authors.initials: A
authors.lastname: Mézière
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.forename: Marc
authors.initials: M
authors.lastname: Verny
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Frédéric
authors.initials: F
authors.lastname: Khiami
authors.forename: Jacques
authors.initials: J
authors.lastname: Boddaert
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000097:blood* / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000601:surgery*; D006801:Humans; D008297:Male; D059035:Perioperative Period; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology; D011379:Prognosis; D020127:Recovery of Function; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I