Postoperative myocardial damages are a key issue in patients’ outcome after hip fracture

摘要

SIR—We read with interest the article by Chong et al. on thenincidence of postoperative myocardial damages (PMD) measurednby troponin (Tn) release after emergency orthopaedicnsurgery in older patients and its relationship with latenmortality [1].nWe fully agree with their conclusion when they say thatnPMD are very common after hip fracture. Indeed, two studiesnhave shown similar incidences of such PMD after hipnfracture. In a cohort of 238 patients, Fisher et al. found an29% incidence of PMD [2], and Dawson-Bowling in a samplenof 108 patients a 38% incidence [3]. In these two studies,nthe occurrence of PMD was associated with both morenin-hospital adverse event and in-hospitalmortality. The studynof Chong et al. provides additional data concerning the impactnof PMD on 1-year cardiac outcome confirming that myocardialnischaemia after hip fracture is a major health burden asnclearly shown by Rosencher et al. who found in a cohortnof 6,860 patients that cardiovascular disease was the mostnfrequent cause of death at 6 months [4]. Furthermore, thisnrelationship between early PMD and late cardiac outcomensuggests that the onset of cardiac morbidity appears early innthe course of hip fracture as pointed out by Matot et al. whonfound, in 68 samples of hip fracture patients monitored forncardiac events during their hospital stay, seven (10.3%) preoperativencardiac events and six postoperative cardiac eventsnin the 64 patients who survived to the surgery (9.4%) [5].nThese data are consistent with those concerning the associationnbetween postoperative ischaemia, in-hospital morbiditynand long-term survival rates [6].