TY - JOUR
T1 - Asymptomatic cardiac ischemia pilot (ACIP) study
T2 - Impact of anti-ischemia therapy on 12-week rest electrocardiogram and exercise test outcomes
AU - Chaitman, Bernard R.
AU - Stone, Peter H.
AU - Knatterud, Genell L.
AU - Forman, Sandra A.
AU - Sopko, George
AU - Bourassa, Martial G.
AU - Pratt, Craig
AU - Rogers, William J.
AU - Pepine, Carl J.
AU - Conti, C. Richard
AU - ACIP Investigators, Investigators
N1 - Funding Information:
This study was funded by the National Heart, Lung, and Blood Institute, Cardiac Diseases Branch, DMsion of Heart and Vascular Diseases, National Institutes of Health, Bethesda, Ma~land 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. Manuscript received December 12, 1994; revised manuscript received April 24, 1995, accepted April 25, 1995. Address 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. Address for reprints: ACIP Clinical Coordinating Center, Mawland Medical Research Institute, 600 Wyndhurst Avenue, Baltimore, MaR,land 21210.
PY - 1995/9
Y1 - 1995/9
N2 - Objectives. This report from Be 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 (EGG) 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 exercise induced 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, ischemia-guided 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 re suited 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.
AB - Objectives. This report from Be 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 (EGG) 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 exercise induced 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, ischemia-guided 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 re suited 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.
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U2 - 10.1016/0735-1097(95)00013-T
DO - 10.1016/0735-1097(95)00013-T
M3 - Article
C2 - 7642847
AN - SCOPUS:0029102953
SN - 0735-1097
VL - 26
SP - 585
EP - 593
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -