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ECG-Guided Antiarrhythmic Therapy in Acute Coronary Syndrome: A Multidimensional Assessment of Biomarkers, Cardiac
Xiaolong Li1, Xianfeng Liu2, Ming Jing3
1Procurement Office, The People's Hospital of Menghai County, Xishuangbanna Dai Autonomous Prefecture, 666200, People's Republic of China.
Insights
Electrocardiogram (ECG)-guided antiarrhythmic therapy in acute coronary syndrome (ACS) patients improves arrhythmia control and cardiac recovery. This strategy reduces biomarkers, enhances function, and lowers major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Clinical Trials
- Biomarker Research
Background:
- Acute coronary syndrome (ACS) patients frequently experience arrhythmias, complicating management and prognosis.
- Current antiarrhythmic strategies are often experience-based, lacking objective guidance.
- The impact of a structured, electrocardiogram (ECG)-guided approach on clinical outcomes and biomarkers in ACS with arrhythmias is not well-defined.
Purpose of the Study:
- To evaluate the efficacy of an ECG-guided antiarrhythmic strategy compared to conventional therapy in ACS patients with arrhythmias.
- To assess the impact on serum biomarkers, cardiac function, and quality of life.
- To determine the effect on major adverse cardiovascular events (MACE) over a 6-month period.
Main Methods:
- Prospective observational cohort study of 80 ACS patients with arrhythmias managed via a monitor-alert-response-titration pathway.
- Propensity score-matched controls (n=80) received conventional experience-based therapy.
- Evaluated in-hospital interventions, arrhythmia control, biomarkers (NT-proBNP, hs-cTnI, hs-cTnT, hs-CRP), cardiac function (LVEF, LVEDD, LVEDVI, E/e'), quality of life (SAQ, 6MWT), and 6-month MACE.
Main Results:
- The ECG-guided group showed superior arrhythmia control (93.75% vs 82.50%) and higher beta-blocker utilization.
- Significant reductions in myocardial injury and stress biomarkers were observed earlier in the ECG-guided group.
- Improved cardiac function, enhanced quality of life scores, and a lower 6-month MACE rate (13.75% vs 32.50%) were noted in the ECG-guided cohort.
Conclusions:
- ECG-guided antiarrhythmic therapy enhances pharmacotherapy quality and arrhythmia control in ACS patients.
- This strategy accelerates myocardial recovery, improves cardiac function, and enhances patient quality of life.
- The ECG-guided approach demonstrates potential for reducing long-term cardiovascular risk.
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.
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