髋部骨折患者的心肌损伤：一项HIP ATTACK随机试验子研究

Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.

作者信息

Borges Flavia K, Guerra-Farfan Ernesto, Bhandari Mohit, Patel Ameen, Slobogean Gerard, Feibel Robert J, Sancheti Parag K, Tiboni Maria E, Balaguer-Castro Mariano, Tandon Vikas, Tomas-Hernandez Jordi, Sigamani Alben, Sigamani Alen, Szczeklik Wojciech, McMahon Stephen J, Ślęczka Pawel, Ramokgopa Mmampapatla T, Adinaryanan S, Umer Masood, Jenkinson Richard J, Lawendy Abdel, Popova Ekaterine, Nur Aamer Nabi, Wang Chew Yin, Vizcaychipi Marcela, Biccard Bruce M, Ofori Sandra, Spence Jessica, Duceppe Emmanuelle, Marcucci Maura, Harvey Valerie, Balasubramanian Kumar, Vincent Jessica, Tonelli Ana Claudia, Devereaux P J

机构信息

Population Health Research Institute, Hamilton, Ontario, Canada.

Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

出版信息

J Bone Joint Surg Am. 2024 Dec 18;106(24):2303-2312. doi: 10.2106/JBJS.23.01459. Epub 2024 Jul 25.

DOI:10.2106/JBJS.23.01459

PMID:39052767

Abstract

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.

摘要

背景

髋部骨折后心肌损伤很常见，且预后较差。髋部骨折合并心肌损伤的患者可能会从加速手术中获益，以消除与髋部骨折相关的生理应激。本研究旨在确定在入院时心脏生物标志物/酶测量值升高的髋部骨折患者中，加速手术在90天死亡风险方面是否优于标准治疗。

方法

髋部骨折加速手术治疗与护理追踪（HIP ATTACK）试验是一项随机对照试验，旨在确定髋部骨折的加速手术在降低死亡或主要并发症方面是否优于标准治疗。本亚组研究是对1392例患者（来自原研究的2970例患者）进行的事后分析，这些患者在入院时进行了心脏生物标志物/酶测量（>99.9%进行了肌钙蛋白测量，因此本文通篇使用“肌钙蛋白”一词）。主要结局是全因死亡率。次要复合结局包括随机分组后90天的全因死亡率以及非致命性心肌梗死、中风和充血性心力衰竭。

结果

1392例患者中有322例（23%）在入院时肌钙蛋白升高。在肌钙蛋白升高的患者中，加速手术组从髋部骨折诊断到手术的中位时间为6小时（四分位间距[IQR]=5至13），标准治疗组为29小时（IQR=X至52）。与标准治疗相比，肌钙蛋白升高的患者接受加速手术时死亡风险较低（163例中的17例[10%]对159例中的36例[23%]；风险比[HR]=0.43[95%置信区间（CI）=0.24至0.77]），次要复合结局风险也较低（163例中的23例[14%]对159例中的47例[30%]；HR=0.43[95%CI=0.26至0.72]）。