Tarrant Seth M, Kim Raymond G, McDonogh Jack M, Clapham Matthew, Palazzi Kerrin, Attia John, Balogh Zsolt J
Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
J Clin Med. 2021 May 31;10(11):2441. doi: 10.3390/jcm10112441.
Statins have been shown to reduce myocardial infarction (MI) in cardiac and vascular surgery. MI is common in hip fracture. This study aims to investigate whether statins decrease MI in hip fracture surgery and reduce mortality resulting from MI. Patients aged 65 years and above with a low-energy hip fracture were identified between January 2015 and December 2017. Demographics, comorbidities, predictive scores, medications and outcomes were assessed retrospectively. The primary outcome was inpatient MI. The secondary outcome was inpatient mortality resulting from MI, for which fatal and non-fatal MI were modelled. Regression analysis was conducted with propensity score weighting. Hip fracture occurred in 1166 patients, of which 391 (34%) were actively taking statins. Thirty-one (2.7%) patients were clinically diagnosed with MI. They had a higher inpatient mortality than those who did not sustain an MI (35% vs. 5.3%, < 0.0001). No reduction was seen between statin use and the occurrence of MI (OR = 0.97, 95% CI: 0.45-2.11; = 0.942) including Fluvastatin-equivalent dosage (OR = 1.00, 95% CI: 0.96-1.03, = 0.207). Statins were not associated with having a non-fatal MI (OR 1.47, 95% CI: 0.58-3.71; = 0.416) or preventing fatal MI (OR = 0.40, 95% CI: 0.08-1.93; = 0.255). Preadmission statin use and associations with clinically diagnosed inpatient MI or survival after inpatient MI were not able to be established.
他汀类药物已被证明可降低心脏和血管手术中的心肌梗死（MI）发生率。MI在髋部骨折中很常见。本研究旨在调查他汀类药物是否能降低髋部骨折手术中的MI发生率，并降低因MI导致的死亡率。在2015年1月至2017年12月期间，确定了年龄在65岁及以上的低能量髋部骨折患者。对人口统计学、合并症、预测评分、用药情况和结局进行了回顾性评估。主要结局是住院期间发生的MI。次要结局是因MI导致的住院死亡率，对致命性和非致命性MI进行了建模。采用倾向评分加权进行回归分析。1166例患者发生了髋部骨折，其中391例（34%）正在积极服用他汀类药物。31例（2.7%）患者被临床诊断为MI。他们的住院死亡率高于未发生MI的患者（35%对5.3%，P<0.0001）。在他汀类药物使用与MI发生之间未观察到降低（OR = 0.97，95%CI：0.45 - 2.11；P = 0.942），包括氟伐他汀等效剂量（OR = 1.00，95%CI：0.96 - 1.03，P = 0.207）。他汀类药物与非致命性MI的发生（OR 1.47，95%CI：0.58 - 3.71；P = 0.416）或预防致命性MI（OR = 0.40，95%CI：0.08 - 1.93；P = 0.255）无关。无法确定入院前他汀类药物的使用与临床诊断的住院MI或住院MI后的生存之间的关联。
