Study finds few patients experiencing alarms, and those most at risk were identifiable at baseline
Few arrhythmic complications or conduction system disorders requiring action would go undetected if hospitals cut routine continuous ECG monitoring after percutaneous coronary intervention (PCI) to save costs, a single-center study suggested.
Among people who received routine telemetry monitoring in the 24 hours after stenting, actionable ECG alarms occurred in only 2.2% of cases, reported Mandeep Singh, MD, MPH, of Mayo Clinic in Rochester, Minnesota, and colleagues.
These alarms signaled serious events, however, as the rate of all-cause mortality within 30 days reached 6.5% for patients who had actionable alarms and 0.3% for those without (P=0.001), Singh's group reported in the January 2020 issue of Circulation: Cardiovascular Interventions.
"Low-risk patients undergoing elective uncomplicated PCI will unlikely benefit from continuous cardiac monitoring, which can lead to substantial cost saving," they wrote.
The study included 1,278 consecutive patients who collectively underwent 1,358 PCI procedures according to the Mayo Clinic PCI registry. Singh and colleagues estimated that Mayo could have saved $622,481 in total with these cases if it had selected patients for monitoring according to current American Heart Association (AHA) guidelines, which recommend no monitoring for uncomplicated elective PCI and 24 hours of monitoring for uncomplicated PCI for non-ST-segment elevation MI or ST-segment elevation MI.
However, three arrhythmic complications would have been missed if hospital staff had followed the minimal AHA requirements for cardiac monitoring instead of performing it routinely, according to the group.
"Tailored telemetry monitoring to an at-risk population, such as patients with ACS presentation, left main and multivessel disease, hemodynamic instability (shock), and not achieving optimal PCI results, can potentially reduce cost of post-PCI care without compromising safety and increase the usefulness and efficacy of monitoring systems," the investigators wrote.
They had found that ECG alarms were more frequent in older people and those who presented with acute congestive heart failure, non-ST-segment elevation MI, multivessel disease, or left main disease.
Individuals included in the study got PCI in 2015-2017 and had agreed to participate in the research. All were taken to non-ICU wards following the procedure.
Patients averaged age 69 and over 70% were men. ACS was the indication for stenting in 72.8% of cases.
When they did occur, actionable ECG alarms rang at a median of 5.5 hours following the procedure. These alarms were associated with complicated hospital stays with notable increases in permanent pacemakers or implantable cardioverter-defibrillator implantation, use of antiarrhythmic drugs, and transfer to ICU, according to the report.
The length of hospital stay was similar for people who did and did not have actionable alarms.
Given that the study excluded high-risk patients in cardiac ICUs who required continuous cardiac monitoring, the results may not apply to them, Singh and colleagues cautioned. Furthermore, they acknowledged that they did not consider the ST segment nor track QT prolongation in their analysis of malignant arrhythmias.
The group also stressed that post-PCI arrhythmic events are not benign, such that patients at high risk do need monitoring: "Our results are concordant with a majority of the studies that demonstrated increased in-hospital and 30-day mortality in ACS [acute coronary syndrome] patients who developed sustained VT [ventricular tachycardia] or VF [ventricular fibrillation] during hospitalization."
Singh had no disclosures.
Circulation: Cardiovascular Interventions
Source Reference: Al-Hijji MA, et al "Routine continuous electrocardiographic monitoring following percutaneous coronary interventions" Circ Cardiovasc Interv 2019; DOI: 10.1161/CIRCINTERVENTIONS.119.008290.
Read the original article on Medpage Today: Time to Get Selective About Cardiac Telemetry Post-PCI?