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