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.

中文翻译：

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髋部骨折患者的心肌损伤：髋关节发作随机试验子研究。


背景 髋部骨折后心肌损伤很常见，预后不良。髋部骨折和心肌损伤患者可能受益于加速手术，以消除与髋部骨折相关的生理压力。本研究旨在确定加速手术是否优于标准护理，即在到达医院时心脏生物标志物/酶测量值升高的髋部骨折患者的 90 天死亡风险方面。方法 HIP 骨折加速手术治疗和护理 tracK （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减少死亡或主要并发症方面是否优于标准护理。该子研究是对 1392 名患者（来自对 2970 名患者的原始研究）的事后分析，这些患者在到达医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“肌钙蛋白”是整篇论文中使用的术语）。主要结局是全因死亡率。次要复合结局包括随机分组后 90 天全因死亡率和非致命性心肌梗死、卒中和充血性心力衰竭。结果 1392 例患者中有 322 例 （23%） 在到达医院时肌钙蛋白升高。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 （四分位距 [IQR] = 5 至 13），标准治疗组为 29 小时 （IQR = 19 至 52）。与标准治疗相比，肌钙蛋白升高患者接受加速手术的死亡风险较低（163 例中的 17 [10%] 对 159 例中的 36 [23%];风险比 [HR] = 0.43 [95% 置信区间 （CI） = 0.24 至 0。77]）和次要复合结局的风险较低（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]）。结论 每 5 例髋部骨折患者中就有 1 例表现为心肌损伤。这些患者的加速手术导致死亡风险低于标准护理;然而，这些发现需要得到证实。证据级别 治疗 I 级 .有关证据级别的完整描述，请参阅作者说明。