Department of Cardiology, Royo Villanova Hospital, Zaragoza, Spain.
Department of Surgery, University of Zaragoza, Zaragoza, Spain; Aragón's Health Research Institute, Zaragoza, Spain.
Injury. 2020 Apr;51 Suppl 1:S30-S36. doi: 10.1016/j.injury.2020.03.052. Epub 2020 Apr 25.
Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.
骨质疏松性髋部骨折（OHF）是一种与年龄相关的日益频繁的疾病，术后第一年的功能丧失和死亡率很高。本研究评估了术前脑钠肽（NT-proBNP）和肌钙蛋白 I 水平是否与 OHF 修复手术后早期（30 天）发生主要不良心血管事件（MACE）有关。在 6 个月的时间内，前瞻性地收集了来自连续患者的围手术期临床和分析数据，这些患者没有已知的心血管病史，并在单一中心接受 OHF 修复手术。MACE 定义为急性心肌缺血或梗死、急性心力衰竭或心血管死亡。在纳入的 140 名患者中，23 名（16.4%）发生术后 MACE（MACE 组），117 名未发生（对照组）。与对照组相比，MACE 组患者年龄较大，身体状况较差（ASA III-IV），术前更频繁接受红细胞输血（RBCT），血红蛋白浓度较低，NT-proBNP、肌酐和肌钙蛋白 I 浓度较高。总体而言，MACE 组的 RBCT 需求和 30 天死亡率也较高。然而，在多变量分析中，只有术前 RBCT、肌酐 >1mg/dL 和 NT-proBNP >450pg/mL 仍然是术后 MACE 的独立术前危险因素，而优势比的 95%置信区间较宽。尽管我们的研究结果需要在更大的多中心队列中得到证实，但确定 OHF 修复手术后早期术后 MACE 的危险因素可能有助于在手术前和手术后评估患者的风险，并针对他们进行适当的预防和/或治疗干预。
