Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
J Orthop Surg Res. 2024 May 21;19(1):306. doi: 10.1186/s13018-024-04757-1.
This article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients.
This article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation.
1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation.
Our research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.
本文主要研究老年髋部骨折合并冠心病（CHD）患者术后急性心肌梗死（AMI）的危险因素，构建预测模型，并评估所有患者的预后。
本研究回顾性收集了 2019 年 1 月至 2021 年 12 月在河北医科大学第三医院接受髋部骨折手术的老年髋部骨折合并 CHD 患者。从病历系统中收集人口统计学数据、实验室指标和影像学检查结果。采用单因素和多因素 logistic 回归确定术后 AMI 的危险因素，并建立列线图预测模型。使用 R 语言软件绘制 ROC 曲线、校准曲线和 DCA 决策曲线。对训练集中的患者进行 2 年随访，评估其生存情况。
1094 例符合条件的患者分为训练集（n=824，2019 年 1 月 1 日至 2021 年 9 月 31 日）和验证集（n=270，2021 年 10 月 1 日至 2022 年 12 月 31 日）。在训练集中，女性占 58.6%；患者平均年龄为 79.45 岁；主要骨折类型为股骨转子间骨折。有 64.7%的患者接受了β受体阻滞剂治疗；共有 166 例（20.1%）患者接受了经皮冠状动脉介入治疗（PCI）；高血压占 55.5%；520 例（63.1%）患者术前等待时间大于 3 天；入院时平均血红蛋白值为 101.36 g/L；术中平均出血量为 212.42 ml；平均手术时间为 2.5±0.3 h；区域麻醉占 29.7%；63 例（68.5%）AMI 患者无明显临床症状；68 例（73.9%）AMI 患者心电图无 ST 段抬高；术后 AMI 的危险因素为年龄、入院时血红蛋白、糖尿病、慢性肾脏病、术中出血和区域麻醉。列线图预测模型的 AUC 为 0.729。验证集中的 AUC 为 0.783。生存分析显示，AMI 患者与非 AMI 患者的 2 年死亡率存在显著统计学差异，在所有 AMI 患者中，心电图 ST 段抬高患者的死亡率高于无心电图 ST 段抬高患者。
本研究结果发现，老年髋部骨折合并 CHD 患者术后 AMI 的发生率为 11.1%。年龄、糖尿病、入院时血红蛋白、区域麻醉、慢性肾脏病和术中出血是危险因素。训练集中列线图的 AUC 为 0.729。AMI 患者的 2 年死亡率高于非 AMI 患者。
