高リスクの急性冠動脈症候群の患者の歩行用心電図モニタリングの評価:MONITOR ACS-Epic 13ランダム化試験
Jose M De La Torre Hernandez1, Victor Exposito1, Susana Gonzalez Enriquez1
1Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
Frontiers in cardiovascular medicine
|September 3, 2025
まとめ
高リスクの急性冠動脈症候群 (ACS) の患者では,遠隔モニタリングにより不律と伝導異常の検出が著しく増加しました. この試験では重大な心血管疾患に 影響を及ぼさなかったが,重要な心電図の診断結果が改善された.
科学分野:
- 心臓病科
- 臨床試験
- デジタル・ヘルス
背景:
- 急性冠動脈症候群 (ACS) の患者はフォローアップ中に有害事象のリスクに直面します.
- これらの有害事象の前にはしばしば無症状の心律乱がある.
- 遠隔モニタリングによる心電図の変化の早期発見は,治療と予後に影響を及ぼします.
研究 の 目的:
- 高リスクのACS患者における心律乱や伝導異常の検出のための遠隔遠隔モニタリングの有効性を評価する.
- 遠隔モニタリングが12ヶ月以内に発生した重大な心血管疾患 (MACE) に与える影響を評価する.
主な方法:
- 150人の高リスクACS患者 (GRACEスコア > 118,CHA2DS2- VAScスコア > 2) を対象とした単一センターのランダム化比較試験.
- 介入グループは,埋め込み可能なループレコーダーおよび/ または携帯可能な心電図で12ヶ月間モニタリングを受けた.
- 対照群は標準的な治療を受けた.
主要な成果:
- 主要エンドポイント (心房細動/鼓動,心房不律,または高度な伝導異常の検出) は,モニター群の21. 3%で,対照群の2. 7%で達成されました (p=0. 0005).
- 動脈動は,モニタリンググループにおいて有意に増加した (10. 6%対1. 3%,p=0. 016).
- 12ヶ月の死亡,心筋梗塞,脳卒中の発生率は,グループごとに似ていた (5. 3% vs 9. 3%,p=0. 34).
結論:
- 高リスクのACS患者では,通常の治療と比較して,遠隔診療による遠隔モニタリングにより,臨床的に重要なECGの検出が著しく増加します.
- 1年間のMACEの違いを証明するには,研究が不足していた.
- 遠隔モニタリングは,この集団における心律不全と伝導異常の診断に優れています.
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