Arrhythmia monitoring and outcome after myocardial infarction (BIO|GUARD-MI): a randomized trial

Cardiac arrhythmias predict poor outcome after myocardial infarction (MI). We studied if arrhythmia monitoring with an insertable cardiac monitor (ICM) can improve treatment and outcome. BIO|GUARD-MI was a randomized, international open-label study with blinded outcome assessment. Tertiary care facilities monitored the arrhythmias, while the follow-up remained with primary care physicians. Patients after ST-elevation (STEMI) or non-ST-elevation MI with an ejection fraction >35% and a CHA DS -VASc score ≥4 (men) or ≥5 (women). Patients were randomly assigned to receive or not receive an ICM in addition to standard post-MI treatment. Device-detected arrhythmias triggered immediate guideline recommended therapy changes via remote monitoring. MACE, defined as a composite of cardiovascular death or acute unscheduled hospitalization for cardiovascular causes. 790 patients (mean age 71 years, 72% male, 51% non-STEMI) of planned 1,400 pts were enrolled and followed for a median of 31.6 months. At 2 years, 39.4% of the device group and 6.7% of the control group had their therapy adapted for an arrhythmia [hazard ratio (HR) = 5.9,