PDF(Pubmed)
Abstract：
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.
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.
摘要：
目的：目前的急性心肌梗死（AMI）排除策略受到心肌肌钙蛋白暂时释放的挑战。Copeptin是内源性应激的非特异性生物标志物，在AMI早期升高。涵盖肌钙蛋白仍然正常的早期。结合院前和肽素和院内高敏肌钙蛋白T的加速双标记排除策略可以减少住院时间，从而减少全球医疗保健系统的负担。AROMI试验旨在评估加速双标记排除策略是否可以安全地减少早期排除AMI后出院患者的住院时间。
结果：将被救护车运送到医院的疑似AMI患者以1：1的比例随机分组，以使用院前血液样本中测量的copeptin和在到达医院时测量的高敏肌钙蛋白T进行加速排除或使用0h/3h排除策略进行标准排除。AROMI研究包括4351例疑似AMI患者。在排除AMI后出院的患者中，加速的双标记排除策略将平均住院时间减少了0.9h（95％置信区间0.7-1.1h），并且在30天的主要不良心脏事件方面没有低于标准排除（绝对风险差异-0.4％，95%置信区间-2.5至1.7；非劣效性P值=0.013）。
结论：加速排除AMI的双重标记，使用院前和肽素和第一院内高敏肌钙蛋白T的组合，与使用0h/3h排除策略相比,在不增加30天主要心脏不良事件发生率的情况下减少了住院时间.
结果：将被救护车运送到医院的疑似AMI患者以1：1的比例随机分组，以使用院前血液样本中测量的copeptin和在到达医院时测量的高敏肌钙蛋白T进行加速排除或使用0h/3h排除策略进行标准排除。AROMI研究包括4351例疑似AMI患者。在排除AMI后出院的患者中，加速的双标记排除策略将平均住院时间减少了0.9h（95％置信区间0.7-1.1h），并且在30天的主要不良心脏事件方面没有低于标准排除（绝对风险差异-0.4％，95%置信区间-2.5至1.7；非劣效性P值=0.013）。
结论：加速排除AMI的双重标记，使用院前和肽素和第一院内高敏肌钙蛋白T的组合，与使用0h/3h排除策略相比,在不增加30天主要心脏不良事件发生率的情况下减少了住院时间.
