Author + information
- Received December 12, 1994
- Revision received April 24, 1995
- Accepted April 25, 1995
- Published online September 1, 1995.
- Bernard R. Chaitman, MD, FACC1,
- Peter H. Stone, MD, FACC,
- Genell L. Knatterud, PhD,
- Sandra A. Forman, MA,
- George Sopko, MD,
- Martial G. Bourassa, MD, FACC,
- Craig Pratt, MD, FACC,
- William J. Rogers, MD, FACC,
- Carl J. Pepine, MD, FACC,
- C. Richard Conti, MD, FACC and
- ACIP Investigators2
- ↵1Address for correspondence: Dr. Bernard R. Chaitman, Division of Cardiology, Saint Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, P.O. Box 15250, Saint Louis, Missouri 63110-0250.
- ↵2Address for reprints: ACIP Clinical Coordinating Center, Maryland Medical Research Institute, 600 Wyndhurst Avenue, Baltimore, Maryland 21210.
Objectives This report from the Asymptomatic Cardiac Ischemia Pilot (ACIP) study examines differences in the magnitude of reduction of myocardial ischemia as determined by exercise treadmill testing in patients randomized to three different treatment strategies: angina-guided medical therapy, ischemia-guided medical therapy and coronary revascularization.
Background No prospective randomized clinical trials in patients with exercise electrocardiographic (ECG) abnormalities and asymptomatic cardiac ischemia on ambulatory ECG monitoring have compared the impact of different treatment strategies, including coronary revascularization, in terms of reducing myocardial ischemia.
Methods The ACIP exercise protocol was used. Exercise variables measured included final exercise stage; presence of exerciseinduced angina or ischemia; time to angina; time to 1-mm ST segment depression; number of exercise ECG leads with abnormalities; maximal depth of ST segment depression in any lead; sum of ST segment depression; ST/HR index; and rate-pressure product at time to angina, at time to 1-mm ST segment depression and at peak exertion.
Results Peak exercise time was increased by 0.5, 0.7 and 1.6 min in patients assigned to the angina-guided, ischemiaguided and coronary revascularization strategies, respectively, from the qualifying visit to the 12-week visit (p < 0.001). At the qualifying visit, the sum of exercise-induced ST segment depression was 9.4 ± 5.0 (mean ± SD), 9.6 ± 4.7 and 9.9 ± 5.5 mm (p = NS) in the three treatment strategies, respectively. At the 12-week visit, the sum of exercise-induced ST segment depression was 7.4 ± 5.7, 6.8 ± 5.3 and 5.6 ± 5.6 mm (p = 0.02) in the three treatment strategies, respectively. Each treatment strategy resulted in a significant reduction in all exercise-induced variables of myocardial ischemia measured at 12 weeks.
Conclusions Coronary revascularization significantly reduced the extent and frequency of exercise-induced myocardial ischemia compared with either medical strategy. The prognostic impact of these observations should be evaluated in a large-scale multicenter clinical trial.
This study was funded by the National Heart, Lung, and Blood Institute, Cardiac Diseases Branch, Division of Heart and Vascular Diseases, National Institutes of Health, Bethesda, Maryland by research contracts HV-90-07, HV-90-08, HV-91-05 to HV-91-14. Study medications and placebo were donated by Zeneca Pharma Inc., Wilmington, Delaware; Marion-Merrell Dow, Kansas City, Missouri; and Pfizer, New York, New York. Support for exercise electrocardiographic data collection was provided in part by Marquette Electronics, Milwaukee, Wisconsin and by Quinton Instruments, Seattle, Washington. A list of participating centers and investigators for the ACIP study appears in reference 28.
* See Correction on page 842.
- Received December 12, 1994.
- Revision received April 24, 1995.
- Accepted April 25, 1995.
- American College of Cardiology