Accelerated -Rule-Out of acute Myocardial Infarction using prehospital copeptin and in-hospital troponin: The AROMI study.

Autor:	Pedersen CK; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark., Stengaard C; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark., Bøtker MT; Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, Aarhus N 8200, Denmark.; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus N 8200, Denmark.; Department of Anaesthesiology, Randers Regional Hospital, Skovlyvej 15, Randers NØ 8930, Denmark., Søndergaard HM; Department of Cardiology, Viborg Regional Hospital, Heibergs Alle 5A, Viborg 8800, Denmark., Dodt KK; Department of Internal Medicine, Horsens Regional Hospital, Sundvej 30, Horsens 8700, Denmark., Terkelsen CJ; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Oct 12; Vol. 44 (38), pp. 3875-3888.
DOI:	10.1093/eurheartj/ehad447
Abstrakt:	Aims: 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. Methods and Results: 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). Conclusion: 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. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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