Key result
ICM telemonitoring yields ~12-fold higher serious arrhythmic event detection in post-MI patients.
Why the study?
Does implantable cardiac monitor-based telemonitoring increase serious arrhythmic event detection compared to conventional follow-up across different infarct types (STEMI vs. NSTEMI) in MI survivors with LVEF 36-50% and cardiac autonomic dysfunction?
RCT (n=400)
Randomized
Does implantable cardiac monitor-based telemonitoring increase serious arrhythmic event detection compared to conventional follow-up across different infarct types (STEMI vs. NSTEMI) in MI survivors with LVEF 36-50% and cardiac autonomic dysfunction?
Implantable cardiac monitor-based telemonitoring significantly increases the detection of serious arrhythmic events—which strongly predict subsequent MACCE—in both high-risk STEMI and NSTEMI survivors with mildly to moderately reduced LVEF and autonomic dysfunction.
Answers are grounded in this paper and cite their sources.
ICM monitoring increases SArE detection similarly in STEMI and NSTEMI without significant interaction; leaves open clinically relevant effect modification by infarct type.
BACKGROUND: Patients with LVEF 36-50% and cardiac autonomic dysfunction remain at risk after myocardial infarction (MI) despite not qualifying for primary-preventive defibrillator therapy. Implantable cardiac monitor (ICM)-based telemonitoring facilitates early detection of serious arrhythmic events (SArE), however it remains unclear whether infarct type modifies the detection and prognostic significance of SArE. OBJECTIVE: To compare the effect of ICM monitoring on SArE detection by infarct type and explore associations with subsequent major adverse cardiovascular and cerebrovascular events (MACCE). METHODS: SMART-MI randomized MI survivors with LVEF 36-50% and cardiac autonomic dysfunction to ICM-based telemonitoring or conventional follow-up. Cox models assessed effects on SArE detection and treatment-by-infarct-type interaction. Exploratory analyses modeled detected SArE as a time-dependent covariate, stratified by arm, for subsequent MACCE. RESULTS: 400 patients were randomized to ICM implantation (n=201, 122 STEMI) or conventional follow-up (n=199, 114 STEMI). Telemedical monitoring increased SArE detection in STEMI (HR 11.99, 95% CI 3.67-39.17) and NSTEMI (HR 4.44, 95% CI 2.09-9.43; both p<0.001). Although the effect was numerically greater in STEMI, clinically relevant effect modification cannot be excluded (p for interaction=0.154). Detected SArE were associated with subsequent MACCE in both, STEMI and NSTEMI with HR of 7.77 (95% CI 3.20-18.86) and 4.26 (95% CI 1.44-12.58), respectively. CONCLUSION: ICM-based telemonitoring increased SArE detection in both STEMI and NSTEMI patients and detected SArE were associated with subsequent MACCE in both infarct types. These findings support further investigation of intensified rhythm-surveillance strategies in high-risk STEMI and NSTEMI patients.
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Dolejsi et al. (2026) conducted an RCT in Myocardial infarction (STEMI and NSTEMI) with LVEF 36-50% and cardiac autonomic dysfunction (n=400). Implantable cardiac monitor (ICM)-based telemonitoring vs. Conventional follow-up was evaluated on Serious arrhythmic event (SArE) detection (HR 11.99 in STEMI; HR 4.44 in NSTEMI, 95% CI 3.67-39.17 in STEMI; 2.09-9.43 in NSTEMI, p=<0.001 for both; p for interaction=0.154). ICM-based telemonitoring increased serious arrhythmic event detection in both STEMI (HR 11.99, 95% CI 3.67-39.17) and NSTEMI (HR 4.44, 95% CI 2.09-9.43; both p<0.001; p-interaction=0.154).
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