Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery

Bhanu P. Gupta, Jeanne M. Huddleston, Lisa L. Kirkland, Paul M. Huddleston, Dirk R. Larson, Rachel E. Gullerud, M. Caroline Burton, Charanjit S. Rihal, R. Scott Wright

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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). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)713-716
Number of pages4
JournalJournal of Hospital Medicine
Volume7
Issue number9
DOIs
StatePublished - Nov 2012

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Hip Fractures
Myocardial Infarction
Mortality
Confidence Intervals
Troponin
Hospital Mortality
Case-Control Studies
Inpatients
Biomarkers
Odds Ratio
Guidelines
Incidence

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

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Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery. / Gupta, Bhanu P.; Huddleston, Jeanne M.; Kirkland, Lisa L.; Huddleston, Paul M.; Larson, Dirk R.; Gullerud, Rachel E.; Burton, M. Caroline; Rihal, Charanjit S.; Wright, R. Scott.

In: Journal of Hospital Medicine, Vol. 7, No. 9, 11.2012, p. 713-716.

Research output: Contribution to journalArticle

Gupta, Bhanu P. ; Huddleston, Jeanne M. ; Kirkland, Lisa L. ; Huddleston, Paul M. ; Larson, Dirk R. ; Gullerud, Rachel E. ; Burton, M. Caroline ; Rihal, Charanjit S. ; Wright, R. Scott. / Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery. In: Journal of Hospital Medicine. 2012 ; Vol. 7, No. 9. pp. 713-716.
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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). CONCLUSION: 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.",
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N2 - 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). CONCLUSION: 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.

AB - 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). CONCLUSION: 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.

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