Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(10):61 J Bone Joint Surg Am . 2024 Dec 18;106(24):2303-2312.What this means for my practice?
Clinicians should recognize that myocardial injury in hip fracture patients is common and portends a poor prognosis, but accelerated surgery can significantly reduce mortality and major cardiac events in this group. This supports a shift away from delaying surgery for additional cardiac evaluation. However, findings are from a post-hoc analysis and require confirmation in a dedicated trial.
Study Summary
One thousand three hundred ninety-two patients with hip fracture who had a baseline troponin measurement were included in this post-hoc analysis of the HIP ATTACK trial. Of these, 322 (23%) presented with myocardial injury, defined by an elevated troponin level. These patients were randomized to receive either accelerated surgery (n=163) or standard care (n=159). The primary outcome was 90-day all-cause mortality. Secondary outcomes included a composite of all-cause mortality, non-fatal myocardial infarction, stroke, and congestive heart failure. Outcomes were assessed at 90 days post-randomization. Overall, the results revealed that patients with troponin elevation had significantly lower 90-day mortality with accelerated surgery (10%) compared to standard care (23%), along with fewer major cardiovascular complications. These findings suggest that accelerated surgery may be beneficial for hip fracture patients presenting with myocardial injury.
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