Background. Serum cardiac biomarkers have recently been demonstrated to be useful for predicting perioperative complication after hip fracture (HF). However, no previous study has revealed the comparative efficacy of different cardiac biomarkers in high surgical risk HF patients. Methods. A prospective study was conducted, from June to December 2016, in 20 acute HF patients with American Society of Anesthesiologists (ASA) grade 3 or 4. All patients received blood test for high sensitivity Troponin-I (hsTnI) and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) at the time of admission and 24 hours postoperatively. Perioperative data and in-hospital, 3-month, and 6-month postoperative complications were collected. The complications were classified as cardiac and noncardiac HF-related complications. Results. The average patients' age was 79±8 years. Six patients (30%) were male. The incidence of PCI was 30% (n=6). None of the patients (0%) died during the 6-month postoperative followup period. In-hospital overall cardiac and noncardiac complications were found in 12(60%), 5(30%), and 7(45%), respectively. The mean serum hsTnI levels in the patients with cardiac complication were significantly greater than those in the patients without cardiac complication at both time of admission (99.5 ng/mL vs 5.5 ng/mL, p=0.006) and 24 hours postoperatively (28.6 ng/mL vs 9.4 ng/mL, p=0.013). The mean serum NT-proBNP levels in patients with cardiac complication were also greater but nonsignificantly compared to those in the patients without cardiac complication at both time of admission (2299 pg/mL vs 281 pg/mL, p=0.239) and 24 hours postoperatively (2266 pg/mL vs 586 pg/mL, p=0.061). The other significant preoperative predictors for cardiac complication were low hemoglobin level (p=0.014), low glomerular filtration rate level (p=0.039), and ASA grade 4 (p=0.005). Conclusion. In-hospital cardiac complication in high-risk HF patients was significantly associated with the abnormal rise of serum hsTnI level. Therefore, we recommended using the hsTnI test in the perioperative evaluation in high-risk HF patients. Trial registration number is TCTR20160711002.