TY - JOUR
T1 - Myocardial Injury in Patients with Hip Fracture
T2 - A HIP ATTACK Randomized Trial Substudy
AU - Borges, Flavia K.
AU - Guerra-Farfan, Ernesto
AU - Bhandari, Mohit
AU - Patel, Ameen
AU - Slobogean, Gerard
AU - Feibel, Robert J.
AU - Sancheti, Parag K.
AU - Tiboni, Maria E.
AU - Balaguer-Castro, Mariano
AU - Tandon, Vikas
AU - Tomas-Hernandez, Jordi
AU - Sigamani, Alben
AU - Sigamani, Alen
AU - Szczeklik, Wojciech
AU - Mcmahon, Stephen J.
AU - Ślȩczka, Pawel
AU - Ramokgopa, Mmampapatla T.
AU - Adinaryanan, S.
AU - Umer, Masood
AU - Jenkinson, Richard J.
AU - Lawendy, Abdel
AU - Popova, Ekaterine
AU - Nur, Aamer Nabi
AU - Wang, Chew Yin
AU - Vizcaychipi, Marcela
AU - Biccard, Bruce M.
AU - Ofori, Sandra
AU - Spence, Jessica
AU - Duceppe, Emmanuelle
AU - Marcucci, Maura
AU - Harvey, Valerie
AU - Balasubramanian, Kumar
AU - Vincent, Jessica
AU - Tonelli, Ana Claudia
AU - Devereaux, P. J.
N1 - Publisher Copyright:
Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.
PY - 2024
Y1 - 2024
N2 - Background: Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the hip fracture. This study aimed to determine if accelerated surgery is superior to standard care in terms of the 90-day risk of death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme measurement at hospital arrival. Methods: The HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard care in reducing death or major complications. This substudy is a post-hoc analysis of 1392 patients (from the original study of 2970 patients) who had a cardiac biomarker/enzyme measurement (>99.9% had a troponin measurement and thus "troponin"is the term used throughout the paper) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality and non-fatal myocardial infarction, stroke, and congestive heart failure 90 days after randomization. Results: Three hundred and twenty-two (23%) of the 1392 patients had troponin elevation at hospital arrival. Among the patients with troponin elevation, the median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] = 5 to 13) in the accelerated surgery group and 29 hours (IQR = 19 to 52) in the standard care group. Patients with troponin elevation had a lower risk of mortality with accelerated surgery compared with standard care (17 [10%] of 163 versus 36 [23%] of 159; hazard ratio [HR] = 0.43 [95% confidence interval (CI) = 0.24 to 0.77]) and a lower risk of the secondary composite outcome (23 [14%] of 163 versus 47 [30%] of 159; HR = 0.43 [95% CI = 0.26 to 0.72]). Conclusions: One in 5 patients with a hip fracture presented with myocardial injury. Accelerated surgery resulted in a lower mortality risk than standard care for these patients; however, these findings need to be confirmed.
AB - Background: Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the hip fracture. This study aimed to determine if accelerated surgery is superior to standard care in terms of the 90-day risk of death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme measurement at hospital arrival. Methods: The HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard care in reducing death or major complications. This substudy is a post-hoc analysis of 1392 patients (from the original study of 2970 patients) who had a cardiac biomarker/enzyme measurement (>99.9% had a troponin measurement and thus "troponin"is the term used throughout the paper) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality and non-fatal myocardial infarction, stroke, and congestive heart failure 90 days after randomization. Results: Three hundred and twenty-two (23%) of the 1392 patients had troponin elevation at hospital arrival. Among the patients with troponin elevation, the median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] = 5 to 13) in the accelerated surgery group and 29 hours (IQR = 19 to 52) in the standard care group. Patients with troponin elevation had a lower risk of mortality with accelerated surgery compared with standard care (17 [10%] of 163 versus 36 [23%] of 159; hazard ratio [HR] = 0.43 [95% confidence interval (CI) = 0.24 to 0.77]) and a lower risk of the secondary composite outcome (23 [14%] of 163 versus 47 [30%] of 159; HR = 0.43 [95% CI = 0.26 to 0.72]). Conclusions: One in 5 patients with a hip fracture presented with myocardial injury. Accelerated surgery resulted in a lower mortality risk than standard care for these patients; however, these findings need to be confirmed.
UR - http://www.scopus.com/inward/record.url?scp=85199714096&partnerID=8YFLogxK
U2 - 10.2106/JBJS.23.01459
DO - 10.2106/JBJS.23.01459
M3 - Article
C2 - 39052767
AN - SCOPUS:85199714096
SN - 0021-9355
JO - Journal of Bone and Joint Surgery - Series A
JF - Journal of Bone and Joint Surgery - Series A
ER -