Flavia K Borges, Ernesto Guerra-Farfan, Mohit Bhandari, Ameen Patel, Gerard Slobogean, Robert J Feibel, Parag K Sancheti, Maria E Tiboni, Mariano Balaguer-Castro, Vikas Tandon, Jordi Tomas-Hernandez, Alben Sigamani, Alen Sigamani, Wojciech Szczeklik, Stephen J McMahon, Pawel Ślęczka, Mmampapatla T Ramokgopa, S Adinaryanan, Masood Umer, Richard J Jenkinson, Abdel Lawendy, Ekaterine Popova, Aamer Nabi Nur, Chew Yin Wang, Marcela Vizcaychipi, Bruce M Biccard, Sandra Ofori, Jessica Spence, Emmanuelle Duceppe, Maura Marcucci, Valerie Harvey, Kumar Balasubramanian, Jessica Vincent, Ana Claudia Tonelli, P J Devereaux
{"title":"髋部骨折患者的心肌损伤：HIP ATTACK 随机试验子研究。","authors":"Flavia K Borges, Ernesto Guerra-Farfan, Mohit Bhandari, Ameen Patel, Gerard Slobogean, Robert J Feibel, Parag K Sancheti, Maria E Tiboni, Mariano Balaguer-Castro, Vikas Tandon, Jordi Tomas-Hernandez, Alben Sigamani, Alen Sigamani, Wojciech Szczeklik, Stephen J McMahon, Pawel Ślęczka, Mmampapatla T Ramokgopa, S Adinaryanan, Masood Umer, Richard J Jenkinson, Abdel Lawendy, Ekaterine Popova, Aamer Nabi Nur, Chew Yin Wang, Marcela Vizcaychipi, Bruce M Biccard, Sandra Ofori, Jessica Spence, Emmanuelle Duceppe, Maura Marcucci, Valerie Harvey, Kumar Balasubramanian, Jessica Vincent, Ana Claudia Tonelli, P J Devereaux","doi":"10.2106/JBJS.23.01459","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"2303-2312"},"PeriodicalIF":4.4000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.\",\"authors\":\"Flavia K Borges, Ernesto Guerra-Farfan, Mohit Bhandari, Ameen Patel, Gerard Slobogean, Robert J Feibel, Parag K Sancheti, Maria E Tiboni, Mariano Balaguer-Castro, Vikas Tandon, Jordi Tomas-Hernandez, Alben Sigamani, Alen Sigamani, Wojciech Szczeklik, Stephen J McMahon, Pawel Ślęczka, Mmampapatla T Ramokgopa, S Adinaryanan, Masood Umer, Richard J Jenkinson, Abdel Lawendy, Ekaterine Popova, Aamer Nabi Nur, Chew Yin Wang, Marcela Vizcaychipi, Bruce M Biccard, Sandra Ofori, Jessica Spence, Emmanuelle Duceppe, Maura Marcucci, Valerie Harvey, Kumar Balasubramanian, Jessica Vincent, Ana Claudia Tonelli, P J Devereaux\",\"doi\":\"10.2106/JBJS.23.01459\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":15273,\"journal\":{\"name\":\"Journal of Bone and Joint Surgery, American Volume\",\"volume\":\" \",\"pages\":\"2303-2312\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Bone and Joint Surgery, American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.23.01459\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Surgery, American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2106/JBJS.23.01459","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.
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.
Level of evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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