Association between preoperative high sensitive troponin I levels and cardiovascular events after hip fracture surgery in the elderly

Bum Sung Kim, Tae-Hoon Kim, Jeong-Hwan Oh, Chang Hee Kwon, Sung Hea Kim, Hyun-Joong Kim, Heung Kon Hwang, Sang-Man Chung, Bum Sung Kim, Tae-Hoon Kim, Jeong-Hwan Oh, Chang Hee Kwon, Sung Hea Kim, Hyun-Joong Kim, Heung Kon Hwang, Sang-Man Chung

Abstract

Objective: Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery (HFS). We used high sensitive troponin I (hs-TnI) assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events (MACE) in elderly hip fracture patients.

Method: From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure (HF), new-onset atrial fibrillation (AF), myocardial infarction (MI) and cardiovascular re-hospitalization that occurred within 90 days postoperative.

Results: Of 262 HFS patients, MACE developed following HFS in 65 (24.8%). Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-TnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher revised cardiac risk index. A preoperative hs-TnI ≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, preoperative independent predictors for MACE were age > 80 years [adjusted hazard ratio (HR): 1.79, 95% confident interval (CI): 1.03-3.13, P = 0.04], left ventricular ejection fraction (LVEF) < 50% (adjusted HR: 3.17, 95% CI: 1.47-6.82, P < 0.01) and hs-TnI > 6.5 ng/L (adjusted HR: 3.75, 95% CI: 2.09-6.17, P < 0.01).

Conclusion: In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.

Keywords: Cardiovascular complication; High sensitive troponin I; Hip fracture surgery.

Figures

Figure 1.. Kaplan-Meier curve of major adverse…
Figure 1.. Kaplan-Meier curve of major adverse cardiovascular events in all population according to hs-TnI cutoff value.
hs-TnI: high sensitive troponin I; MACE: major adverse cardiovascular event.
Figure 2.. The frequency of major adverse…
Figure 2.. The frequency of major adverse cardiovascular events in the RCRI = 0 subgroup (A); and RCRI = 1 or more subgroups (B) according to hs-TnI cutoff value.
hs-TnI: high sensitive troponin I; MACE: major adverse cardiovascular event; RCRI: revised cardiac risk index.

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