Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance.

摘要

We read with interest the article of Fischer et al. on incidence and significance of troponin levels in the course of hip fracture repair . We fully agree with their conclusion when they say that the troponin elevation is correlated with postoperative outcome. Indeed, several studies have shown that troponin release is a reliable marker of myocardial injury in the postoperative setting. Their introduction, however, leaves out a fair amount of data when they say that there is little agreement on the prognostic value of cardiac troponin in persons undergoing non-cardiac surgery [2-12]. Actually, several studies have been published on this issue.Most of them have focused on high risk patients, i.e. patients undergoing vascular surgery in whom the incidence of these events is extremely high. On these patients, serial troponin measurements are now the main diagnostic tool to detect myocardial ischaemia [7, 8]. Moreover, studies have shown a strong correlation between short-term troponin release and either postoperative complications or long-term cardiac complications, including death after vascular surgery [6, 7]. Thereafter, other studies have addressed the issue of the public health burden of myocardial ischaemia in major non-vascular surgery, especially in elderly patients [2, 9-12]. This concern is of great importance, since, even if the incidence of postoperative ischaemia in non-vascular surgery is low, the number of patients involved is extremely high [13].