Incidence,mortality, and complications of acute myocardial infarction with and without percutaneous coronary intervention in hip fracture patients |
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| Affiliation: | 1. R Adams Cowley Shock Trauma Center Division of Orthopaedic Traumatology 22 S Greene St, Baltimore, MD 21201, United States;2. University of San Diego Department of Mathematics, 5998 Alcala Park, San Diego, CA 92110, United States;1. Orthopaedic Surgery Resident, McGovern Medical School at UTHealth Houston, Houston, TX;2. Orthopaedic Trauma Service, McGovern Medical School at UTHealth Houston, Houston, TX;3. Department of Radiology, McGovern Medical School at UTHealth Houston, Houston, TX;1. Cambridge Orthopaedic Pelvic Unit (COPU), Addenbrooke''s Hospital Major Trauma Centre, Cambridge University Hospitals NHS Foundation Trust, United Kingdom;2. Division of Trauma and Orthopaedic Surgery, University of Cambridge, United Kingdom |
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| Abstract: | ![]()
IntroductionAcute myocardial infarction (AMI) is a common cause of death following hip fracture surgery. This study aimed to determine the incidence and timing of perioperative AMI treated with percutaneous coronary intervention (PCI) in hip fracture patients, and to compare in-hospital mortality and complications between hip fracture patients who did not have an AMI, those who sustained a perioperative AMI and did not undergo PCI, and those who sustained an AMI and underwent PCI.MethodsThe National Inpatient Sample (NIS) was queried from 2010 through the third quarter of 2015 to identify all patients undergoing hip fracture surgery. Patients were stratified into three cohorts: perioperative AMI but no PCI (no PCI cohort), perioperative AMI with PCI (PCI cohort), and no perioperative AMI or PCI (no AMI cohort). Patient demographics, comorbidities, in-hospital mortality, and complications were compared between cohorts. Multivariable logistic regression adjusting for age, sex, procedure, and Elixhauser score was used to assess the relative odds of in-hospital mortality for each cohort.ResultsA total of 1,535,917 hip fracture cases were identified, with 1.9% in the no PCI cohort, 0.01% in the PCI cohort, and 98.0% in the no AMI cohort. In-hospital mortality was lower in the PCI cohort than in the no PCI cohort (8.8% vs. 14%), and was greater for both than in the no AMI cohort (1.6%, p < 0.001 for all). Both the no PCI cohort (OR, 6.1; 95% CI, 5.6–6.6) and PCI cohort (OR, 4.1; 95% CI, 2.8–6.0) had increased adjusted odds of in-hospital mortality compared to the no AMI cohort. The PCI cohort had a higher rate of bleeding complications than both other cohorts, and the no PCI cohort had a higher rate of transfusion than both other cohorts.ConclusionsPerioperative AMI both with and without PCI independently increases the risk of mortality in hip fracture patients, with the highest risk of mortality in those with AMI without PCI. Providers should understand the increased morbidity and mortality associated with AMI in hip fracture patients, as well as the risks and benefits of perioperative PCI, in order to better counsel and manage these patients.Level of EvidenceIII |
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