Abstract 1676: Evaluation of Continuous Holter Monitoring Following Percutaneous Coronary Intervention (PCI) as a Surrogate for Post-PCI Myonecrosis: An Analysis from The PROTECT-TIMI 30 Trial
Background: Compared with serial biomarkers, continuous Holter monitoring following PCI has the advantages of detecting ongoing ischemic events continuously, it allows for early discharge, is not impacted by failure to draw blood and it is not dependent upon the timing of blood draws. The goal of this analysis was to evaluate the potential of post PCI Holter monitoring to serve as a surrogate marker for death/MI within 24 hrs following PCI.
Methods: Post-procedure ischemia was measured using 3 precordial leads among 790 patients enrolled in the PROTECT-TIMI30 trial. An independent core laboratory classified the incidence, duration, timing, and magnitude of ischemia exceeding a threshold of 1 mm ST-segment deviation. The incidence of death/MI was assessed through 24 hrs post-PCI and was adjudicated by an independent clinical events committee. The association of Holter ischemia with death/MI was evaluated using Kaplan-Meier survival analysis adjusted for the timing of ischemia and of the clinical event.
Results: See figure⇓. The median time to the onset of the ischemic event eventuating in death/MI was only 29 minutes following PCI.
Conclusions: Death/MI following PCI is associated with nearly a 15 fold increase in the cumulative duration of Holter ischemia within the first 24 hours, and the onset of the ischemic event typically occurs within the first half hour after PCI. Holter monitoring may represent a valuable tool to facilitate a complete and ongoing assessment of post PCI ischemic events despite early hospital discharge.