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

TY - JOUR

T1 - Accelerated -Rule-Out of acute Myocardial Infarction using prehospital copeptin and in-hospital troponin

T2 - The AROMI study

AU - Pedersen, Claus Kjær

AU - Stengaard, Carsten

AU - Bøtker, Morten Thingemann

AU - Søndergaard, Hanne Maare

AU - Dodt, Karen Kaae

AU - Terkelsen, Christian Juhl

N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/10

Y1 - 2023/10

N2 - 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.

AB - 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.

KW - Acute myocardial infarction

KW - Chest pain

KW - Copeptin

KW - Diagnosis

KW - Diagnostic tests

KW - Early diagnosis

KW - High-sensitivity cardiac troponin

KW - Myocardial infarction

KW - NSTEMI

KW - Non–ST-elevation myocardial infarction

KW - Rule out

KW - Rule-out

KW - Troponin

KW - Predictive Value of Tests

KW - Humans

KW - Troponin T

KW - Hospitals

KW - Myocardial Infarction/diagnosis

KW - Chest Pain

KW - Biomarkers

KW - Emergency Medical Services

KW - Glycopeptides

UR - http://www.scopus.com/inward/record.url?scp=85173831518&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehad447

DO - 10.1093/eurheartj/ehad447

M3 - Journal article

C2 - 37477353

SN - 0195-668X

VL - 44

SP - 3875

EP - 3888

JO - European Heart Journal

JF - European Heart Journal

IS - 38

ER -