Myocardial Injury in Patients with Hip Fracture : A HIP ATTACK Randomized Trial Substudy
Kessler Borges, Flavia (McMaster University. Department of Medicine)
Guerra-Farfán, Ernesto (Hospital Universitari Vall d'Hebron)
Bhandari, Mohit (McMaster University. Department of Surgery)
Patel, Ameen (McMaster University. Department of Medicine)
Slobogean, Gerard (Department of Orthopaedics. University of Maryland School of Medicine)
Feibel, Robert J. (Department of Surgery. The Ottawa Hospital. University of Ottawa)
Sancheti, Parag K. (Sancheti Institute for Orthopaedics & Rehabilitation)
Tiboni, Maria E. (McMaster University. Department of Medicine)
Balaguer Castro, Mariano (Hospital Clínic i Provincial de Barcelona)
Tandon, Vikas (McMaster University. Department of Medicine)
Tomas-Hernandez, Jordi (Hospital Universitari Vall d'Hebron)
Sigamani, Alben (Numen Health Bangalore)
Sigamani, Alen (Government TD Medical College, Vandanam, India.)
Szczeklik, Wojciech (Center for Intensive Care and Perioperative Medicine. Jagiellonian University Medical College)
Mcmahon, Stephen J. (Oak Valley Health. Department of Surgery)
Ślȩczka, Pawel
Ramokgopa, Mmampapatla T. (Division of Orthopaedic Surgery. University of the Witwatersrand)
Adinaryanan, S. (Department of Anaesthesiology and Critical Care. Jawaharlal Institute of Postgraduate Medical Education and Research)
Umer, Masood (Department of Surgery. Aga Khan University)
Jenkinson, Richard J. (Institute of Health Policy Management and Evaluation. University of Toronto)
Lawendy, Abdel (Lawson Health Research Institute)
Popova, Ekaterine (Iberoamerican Cochrane Center)
Nur, Aamer Nabi (Department of Orthopaedic Surgery. Shifa International Hospital)
Wang, Chew Yin (Department of Anaesthesiology. Faculty of Medicine. University Malaya)
Vizcaychipi, Marcela (Chelsea and Westminster Hospital (Londres, Regne Unit))
Biccard, Bruce M (Groote Schuur Hospital (Observatory, Sud-àfrica))
Ofori, Sandra (Department of Medicine. McMaster University)
Spence, Jessica (Department of Anesthesia and Critical Care. McMaster University)
Duceppe, Emmanuelle (Department of Medicine. University of Montreal)
Marcucci, Maura (Department of Health Research Methods. Evidence. and Impact. McMaster University)
Harvey, Valerie (Population Health Research Institute)
Balasubramanian, Kumar (Department of Statistics. Population Health Research Institute. David Braley Cardiac. Vascular and Stroke Research Institute)
Vincent, Jessica (Perioperative Medicine and Surgical Research Unit. Population Health Research Institute. David Braley Cardiac. Vascular and Stroke Research Institute)
Tonelli, Ana Claudia (Internal Medicine Service. Hospital de Clinicas de Porto Alegre)
Devereaux, P. J (McMaster University. Department of Medicine)

Data:	2024
Resum:	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.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Publicat a:	Journal of bone and joint surgery. American volume, 2024 , ISSN 1535-1386

DOI: 10.2106/JBJS.23.01459

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