Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark.
Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, Aarhus N 8200, Denmark.
Eur Heart J. 2023 Oct 12;44(38):3875-3888. doi: 10.1093/eurheartj/ehad447.
The present acute myocardial infarction (AMI) rule-out strategies are challenged by the late temporal release of cardiac troponin. Copeptin is a non-specific biomarker of endogenous stress and rises early in AMI, covering the early period where troponin is still normal. An accelerated dual-marker rule-out strategy combining prehospital copeptin and in-hospital high-sensitivity troponin T could reduce length of hospital stay and thus the burden on the health care systems worldwide. The AROMI trial aimed to evaluate if the accelerated dual-marker rule-out strategy could safely reduce length of stay in patients discharged after early rule-out of AMI.
Patients with suspected AMI transported to hospital by ambulance were randomized 1:1 to either accelerated rule-out using copeptin measured in a prehospital blood sample and high-sensitivity troponin T measured at arrival to hospital or to standard rule-out using a 0 h/3 h rule-out strategy. The AROMI study included 4351 patients with suspected AMI. The accelerated dual-marker rule-out strategy reduced mean length of stay by 0.9 h (95% confidence interval 0.7-1.1 h) in patients discharged after rule-out of AMI and was non-inferior regarding 30-day major adverse cardiac events when compared to standard rule-out (absolute risk difference -0.4%, 95% confidence interval -2.5 to 1.7; P-value for non-inferiority = 0.013).
Accelerated dual marker rule-out of AMI, using a combination of prehospital copeptin and first in-hospital high-sensitivity troponin T, reduces length of hospital stay without increasing the rate of 30-day major adverse cardiac events as compared to using a 0 h/3 h rule-out strategy.
目前的急性心肌梗死（AMI）排除策略受到心肌肌钙蛋白延迟释放的挑战。 copeptin 是内源性应激的非特异性生物标志物，在 AMI 早期升高，涵盖了肌钙蛋白仍正常的早期阶段。结合院前 copeptin 和院内高敏肌钙蛋白 T 的加速双重标志物排除策略可缩短住院时间，从而减轻全球医疗保健系统的负担。AROMI 试验旨在评估加速双重标志物排除策略是否可以安全缩短 AMI 早期排除后出院患者的住院时间。
疑似 AMI 患者通过救护车送往医院，按 1:1 随机分为两种策略：使用院前样本中测量的 copeptin 和到达医院时测量的高敏肌钙蛋白 T 进行加速排除的策略，或使用 0 h/3 h 排除策略的标准排除策略。AROMI 研究纳入了 4351 例疑似 AMI 患者。与标准排除相比，加速双重标志物排除策略可将 AMI 排除后出院患者的平均住院时间缩短 0.9 小时（95%置信区间 0.7-1.1 小时），并且在 30 天主要不良心脏事件方面非劣效（绝对风险差异 -0.4%，95%置信区间 -2.5 至 1.7；非劣效性检验 P 值=0.013）。
与使用 0 h/3 h 排除策略相比，使用院前 copeptin 和首次院内高敏肌钙蛋白 T 的 AMI 加速双重标志物排除策略可缩短住院时间，而不会增加 30 天主要不良心脏事件的发生率。
