ECG-guided antiarrhythmic therapy reduced 6-month MACE rate from 32.5% to 13.75% compared to conventional therapy in ACS patients with arrhythmias.
Observational (n=160)
Yes
Does an ECG-guided antiarrhythmic strategy improve biomarker profiles, cardiac function, and quality of life in patients with acute coronary syndrome and arrhythmias?
Implementing an ECG-guided monitor-alert-response-titration pathway for antiarrhythmic therapy in ACS patients improves arrhythmia control, cardiac function, and reduces 6-month MACE.
Effect estimate: ARR 18.75%
Absolute Event Rate: 13.75% vs 32.5%
p-value: p=<0.05
Objective: To evaluate the impact of electrocardiogram (ECG)-guided antiarrhythmic strategy on serum biomarkers, cardiac function, and quality of life in patients with acute coronary syndrome (ACS) and arrhythmias. Methods: This prospective observational cohort enrolled 80 ACS patients with arrhythmias managed via a monitor-alert-response-titration pathway (observation group) during January-December 2024. Propensity score-matched controls (n = 80) received conventional experience-based antiarrhythmic therapy. Comparisons included in-hospital antiarrhythmic interventions, arrhythmia control, adverse events, and myocardial injury/stress biomarkers (NT-proBNP, hs-cTnI, hs-cTnT, hs-CRP) at T0 (baseline), T1 (2-day), and T2 (7-day). Cardiac function (LVEF, LVEDD, LVEDVI, E/e′) and patient-reported outcomes Seattle Angina Questionnaire (SAQ), 6-minute walk test (6MWT) were assessed at T0, T3 (1-month), and T4 (6-month). Major adverse cardiovascular events (MACE) were recorded over 6 months. Results: The observation group demonstrated higher β-blocker utilization, guideline adherence, and drug adjustment rates ( P < 0.05). Arrhythmia control was superior in the observation group at T2 (93.75% vs 82.50%, P < 0.05). More pronounced reductions in all biomarkers were observed in the observation group at T1 and T2 ( P < 0.05). Greater improvements in LVEF, LVEDD, LVEDVI, E/e′, SAQ scores, and 6MWT distance were sustained in the observation group at T3 and T4 ( P < 0.05). The 6-month MACE rate was lower in the observation group (13.75% vs 32.50%, P < 0.05). Conclusion: ECG-guided antiarrhythmic therapy improves pharmacotherapy quality and arrhythmia control, accelerating myocardial injury and stress attenuation. This strategy approach enhances cardiac recovery, reverse remodeling, functional capacity, and quality of life, ultimately reducing long-term cardiovascular risk. Keywords: acute coronary syndrome, ECG-guided antiarrhythmic therapy, cardiac function, biomarkers, quality of life
Li et al. (Sun,) conduziram um estudo observacional em pacientes de 18 a 80 anos com síndrome coronariana aguda (STEMI, NSTEMI, angina instável) e arritmias clinicamente significativas apresentando dentro de 24 horas do início dos sintomas (n=160). A terapia antiarrítmica guiada por ECG com um caminho de monitor-alerta-resposta-titulação vs. terapia antiarrítmica convencional baseada em experiência foi avaliada na taxa de eventos cardiovasculares adversos maiores (MACE) em 6 meses (morte cardíaca, infarto do miocárdio não fatal, readmissão por angina instável ou insuficiência cardíaca, revascularização não planejada, eventos arritmicos malignos) (ARR 18,75%, p=<0,05). A terapia antiarrítmica guiada por ECG reduziu a taxa de MACE em 6 meses de 32,5% para 13,75% em comparação com a terapia convencional em pacientes com ACS e arritmias.