ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1646175
Evaluation of ambulatory electrocardiographic monitoring of patients after high-risk acute coronary syndrome. The MONITOR ACS-Epic 13 randomized trial
Provisionally accepted
Jose M De La Torre Hernandez*
Victor Exposito
Susana Gonzalez EnriquezFelipe Rodriguez EntemAdrian Margarida
Tamara García Camarero
Gabriela Veiga FernándezFermin Sainz LasoDae-Hyun LeeAritz Gil Ongay
Sergio BarreraSantiago CatoyaCelia GarilletiRigoberto HernandezCristina ObregonJuan J Olalla- Marqués de Valdecilla University Hospital, Santander, Spain
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Patients with acute coronary syndrome (ACS) may experience adverse events in follow-up. Previous trials have shown that asymptomatic arrhythmias preceded these adverse events in a substantial proportion of patients. Ambulatory remote monitoring may allow early detection of electrocardiographic alterations with therapeutic and prognostic implications. Our aim is to evaluate the efficacy of remote monitoring in this population.Single-centre, randomised, control group trial designed to evaluate the efficacy of 12-month monitoring of high-risk patients after ACS, defined by a GRACE score over 118 and a CHA2DS2-VACS score over 2. In the intervention arm two different systems were implemented, an implantable loop recorder in all patients and a portable mobile ECG system in those suitable. Primary endpoint was detection rates for atrial fibrillation/flutter, ventricular arrhythmias and advanced conduction abnormalities. A total of 150 patients (estimated sample size) were included. Baseline clinical characteristics were comparable. Primary endpoint was achieved in 21.3% of the patients in the MONITORING group and only in 2.7% in the CONTROL group (p=.0.0005). The combined diagnosis of atrial fibrillation/flutter was significantly more frequent in the MONITORING group (10.6% vs 1.3%, p=0.016). The incidence of death, myocardial infarction or stroke at 12 months was 9.3% in the CONTROL group and 5.3% in the MONITORING group (p= 0.34).Ambulatory monitoring of high-risk patients after ACS shows a significantly higher detection of ECG-clinically relevant findings as compared to a control group. This was not translated into a difference in 1-year MACE, though the study was clearly underpowered for these clinical endpoints.
Keywords: Atrial Fibrillation, cardiac arrhythmias, Myocardial Infarction, Continuous monitoring, Implantable loop recorder, Wearable Device
Received: 12 Jun 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 De La Torre Hernandez, Exposito, Gonzalez Enriquez, Rodriguez Entem, Margarida, García Camarero, Veiga Fernández, Sainz Laso, Lee, Gil Ongay, Barrera, Catoya, Garilleti, Hernandez, Obregon and Olalla. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jose M De La Torre Hernandez, Marqués de Valdecilla University Hospital, Santander, Spain
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