Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery
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 19...
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| Veröffentlicht in: | Journal of hospital medicine 2012-11, Vol.7 (9), p.713-716 |
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| creator | 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 |
| description | 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. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine |
| doi_str_mv | 10.1002/jhm.1967 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3822042</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1223432921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4767-22ef5cd60765c5bbbfff0c1ff2ae2987f5402bb85e67f09fafd3664f3849df133</originalsourceid><addsrcrecordid>eNp1kU1v1DAQhiMEoqUg8QuQJS5cUvwRO8kFCa2gCyrQA4ij5TjjXS-OvbWTLRF_Hi_dLh8SF4-leebRjN6ieErwOcGYvtysh3PSivpecUo4ZyUXWNy_-_OWnhSPUtpgXLGGVw-LE0pbLqqanBY_Fs56q5VD2wgJ_KhGGzxSvkdhGnUYAAWDthBtyE9u7gANc9Aq9jYPWW9U1L9GrEfjGtAO4ozA9RDdjExwLtxYv0Jru0UmKj1OEVCa4ipjj4sHRrkETw71rPjy9s3nxbK8_HTxbvH6stRVLeqSUjBc9wLXgmvedZ0xBmtiDFVA26Y2vMK06xoOoja4Ncr0TIjKsKZqe0MYOyte3Xq3UzdAr_OVUTm5jXZQcZZBWfl3x9u1XIWdZA2luKJZ8OIgiOF6gjTKwSYNzikPYUqSUMoqRltKMvr8H3QTpujzeXuKcNISUv0W6hhSimCOyxAs94nKnKjcJ5rRZ38ufwTvIsxAeQvcWAfzf0Xy_fLDQXjgbRrh-5FX8ZvM3ZrLrx8vZMvE1fKKMVmzn4CDvSI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1221519114</pqid></control><display><type>article</type><title>Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery</title><source>MEDLINE</source><source>Wiley Journals</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine</description><identifier>ISSN: 1553-5592</identifier><identifier>EISSN: 1553-5606</identifier><identifier>DOI: 10.1002/jhm.1967</identifier><identifier>PMID: 22956471</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Biomarkers ; Case-Control Studies ; Creatine Kinase, MB Form - blood ; Female ; Hip Fractures - epidemiology ; Hip Fractures - mortality ; Hip Fractures - surgery ; Hospital Mortality ; Humans ; Male ; Myocardial Infarction - blood ; Myocardial Infarction - epidemiology ; Myocardial Infarction - mortality ; Postoperative Complications - epidemiology ; Postoperative Complications - mortality ; Retrospective Studies ; Sex Factors ; Time Factors ; Troponin - blood</subject><ispartof>Journal of hospital medicine, 2012-11, Vol.7 (9), p.713-716</ispartof><rights>Copyright © 2012 Society of Hospital Medicine</rights><rights>Copyright © 2012 Society of Hospital Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4767-22ef5cd60765c5bbbfff0c1ff2ae2987f5402bb85e67f09fafd3664f3849df133</citedby><cites>FETCH-LOGICAL-c4767-22ef5cd60765c5bbbfff0c1ff2ae2987f5402bb85e67f09fafd3664f3849df133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjhm.1967$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjhm.1967$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22956471$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Bhanu P.</creatorcontrib><creatorcontrib>Huddleston, Jeanne M.</creatorcontrib><creatorcontrib>Kirkland, Lisa L.</creatorcontrib><creatorcontrib>Huddleston, Paul M.</creatorcontrib><creatorcontrib>Larson, Dirk R.</creatorcontrib><creatorcontrib>Gullerud, Rachel E.</creatorcontrib><creatorcontrib>Burton, M. Caroline</creatorcontrib><creatorcontrib>Rihal, Charanjit S.</creatorcontrib><creatorcontrib>Wright, R. Scott</creatorcontrib><title>Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery</title><title>Journal of hospital medicine</title><addtitle>J. Hosp. Med</addtitle><description>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. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers</subject><subject>Case-Control Studies</subject><subject>Creatine Kinase, MB Form - blood</subject><subject>Female</subject><subject>Hip Fractures - epidemiology</subject><subject>Hip Fractures - mortality</subject><subject>Hip Fractures - surgery</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - mortality</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - mortality</subject><subject>Retrospective Studies</subject><subject>Sex Factors</subject><subject>Time Factors</subject><subject>Troponin - blood</subject><issn>1553-5592</issn><issn>1553-5606</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhiMEoqUg8QuQJS5cUvwRO8kFCa2gCyrQA4ij5TjjXS-OvbWTLRF_Hi_dLh8SF4-leebRjN6ieErwOcGYvtysh3PSivpecUo4ZyUXWNy_-_OWnhSPUtpgXLGGVw-LE0pbLqqanBY_Fs56q5VD2wgJ_KhGGzxSvkdhGnUYAAWDthBtyE9u7gANc9Aq9jYPWW9U1L9GrEfjGtAO4ozA9RDdjExwLtxYv0Jru0UmKj1OEVCa4ipjj4sHRrkETw71rPjy9s3nxbK8_HTxbvH6stRVLeqSUjBc9wLXgmvedZ0xBmtiDFVA26Y2vMK06xoOoja4Ncr0TIjKsKZqe0MYOyte3Xq3UzdAr_OVUTm5jXZQcZZBWfl3x9u1XIWdZA2luKJZ8OIgiOF6gjTKwSYNzikPYUqSUMoqRltKMvr8H3QTpujzeXuKcNISUv0W6hhSimCOyxAs94nKnKjcJ5rRZ38ufwTvIsxAeQvcWAfzf0Xy_fLDQXjgbRrh-5FX8ZvM3ZrLrx8vZMvE1fKKMVmzn4CDvSI</recordid><startdate>201211</startdate><enddate>201211</enddate><creator>Gupta, Bhanu P.</creator><creator>Huddleston, Jeanne M.</creator><creator>Kirkland, Lisa L.</creator><creator>Huddleston, Paul M.</creator><creator>Larson, Dirk R.</creator><creator>Gullerud, Rachel E.</creator><creator>Burton, M. Caroline</creator><creator>Rihal, Charanjit S.</creator><creator>Wright, R. Scott</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Frontline Medical Communications</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201211</creationdate><title>Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4767-22ef5cd60765c5bbbfff0c1ff2ae2987f5402bb85e67f09fafd3664f3849df133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers</topic><topic>Case-Control Studies</topic><topic>Creatine Kinase, MB Form - blood</topic><topic>Female</topic><topic>Hip Fractures - epidemiology</topic><topic>Hip Fractures - mortality</topic><topic>Hip Fractures - surgery</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - mortality</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - mortality</topic><topic>Retrospective Studies</topic><topic>Sex Factors</topic><topic>Time Factors</topic><topic>Troponin - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Bhanu P.</creatorcontrib><creatorcontrib>Huddleston, Jeanne M.</creatorcontrib><creatorcontrib>Kirkland, Lisa L.</creatorcontrib><creatorcontrib>Huddleston, Paul M.</creatorcontrib><creatorcontrib>Larson, Dirk R.</creatorcontrib><creatorcontrib>Gullerud, Rachel E.</creatorcontrib><creatorcontrib>Burton, M. Caroline</creatorcontrib><creatorcontrib>Rihal, Charanjit S.</creatorcontrib><creatorcontrib>Wright, R. Scott</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of hospital medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Bhanu P.</au><au>Huddleston, Jeanne M.</au><au>Kirkland, Lisa L.</au><au>Huddleston, Paul M.</au><au>Larson, Dirk R.</au><au>Gullerud, Rachel E.</au><au>Burton, M. Caroline</au><au>Rihal, Charanjit S.</au><au>Wright, R. Scott</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery</atitle><jtitle>Journal of hospital medicine</jtitle><addtitle>J. Hosp. Med</addtitle><date>2012-11</date><risdate>2012</risdate><volume>7</volume><issue>9</issue><spage>713</spage><epage>716</epage><pages>713-716</pages><issn>1553-5592</issn><eissn>1553-5606</eissn><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. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>22956471</pmid><doi>10.1002/jhm.1967</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Journals |
| subjects | Age Factors Aged Aged, 80 and over Biomarkers Case-Control Studies Creatine Kinase, MB Form - blood Female Hip Fractures - epidemiology Hip Fractures - mortality Hip Fractures - surgery Hospital Mortality Humans Male Myocardial Infarction - blood Myocardial Infarction - epidemiology Myocardial Infarction - mortality Postoperative Complications - epidemiology Postoperative Complications - mortality Retrospective Studies Sex Factors Time Factors Troponin - blood |
| title | Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery |
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