Background: It was hypothesized that elevations in cardiac biomarkers indicating myocardial injury and strain are frequent in hip fracture patients, but do not always present any symptoms or changes in ECG. 

Aims: To investigate the incidence and prognosis of cardiovascular events in an unselected population of hip fracture patients and to evaluate whether it is reasonable to perform routine cardiac biomarker testing in all hip fracture patients. 

Material and methods: 200 consecutive hip fracture patients were enrolled in Turku University Hospital during 2009 – 2010. For study purposes only, routine measurement of troponin T (TnT) and ECG recordings were performed repeatedly pre- and postoperatively and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) at least once perioperatively. The perioperative complications, 30-day, 2-year, 1000-day and 5-year all-cause mortalities were studied. 

Results: Perioperative TnT elevation as a sign of myocardial injury was detected in a third of the participants, in half of them already preoperatively, and 70% of them had new ischemic ECG changes. Median [IQR] NT-proBNP level was 1415 [2932] ng/l. Participants with biomarker elevation seldom had symptoms suggestive of cardiac origin and the majority of cardiovascular events remained undiagnosed. TnT and NT-proBNP elevation were the only independent predictors of 30-day mortality and remained independent predictors of long-term mortality for the whole 5-year follow-up together with preoperative clinical characteristics. 

Conclusions: TnT and NT-proBNP can detect those hip fracture patients who are suffering from a perioperative cardiovascular event and are at greater risk of death years after the fracture. Routine measurement of these biomarkers in all hip fracture patients could guide evidence-based treatment of perioperative cardiovascular complications.