Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: Outcomes of patients randomized to initial strategies of medical therapy versus revascularization

Richard F. Davies, A. David Goldberg, Sandra Forman, Carl J. Pepine, Genell L. Knatterud, Nancy Geller, George Sopko, Craig Pratt, John Deanfield, C. Richard Conti

Research output: Contribution to journalArticle

374 Scopus citations

Abstract

Background: Patients with ischemia during stress testing and ambulatory ECG monitoring have an increased risk of cardiac events, but it is not known whether their prognosis is improved by more aggressive treatment with anti- ischemic drugs or revascularization. Methods and Results: The Asymptomatic Cardiac Ischemia Pilot study randomized 558 such patients who had coronary anatomy suitable for revascularization to three treatment strategies: angina- guided drug therapy (n = 183), angina plus ischemia-guided drug therapy (n = 183), or revascularization by angioplasty or bypass surgery (n = 192). Two years after randomization, the total mortality was 6.6% in the angina-guided strategy, 4.4% in the ischemia-guided strategy, and 1.1% in the revascularization strategy (P<.02). The rate of death or myocardial infarction was 12.1% in the angina-guided strategy, 8.8% in the ischemia- guided strategy, and 4.7% in the revascularization strategy (p<.04). The rate of death, myocardial infarction, or recurrent cardiac hospitalization was 41.8% in the angina-guided strategy, 38.5% in the ischemia-guided strategy, and 23.1% in the revascularization strategy (P<.001). Pairwise testing revealed significant differences between the revascularization and angina- guided strategies for each comparison. Conclusions: A strategy of initial revascularization appears to improve the prognosis of this population compared with angina-guided medical therapy. A larger long-term study is needed to confirm this benefit and to adequately test the potential of more aggressive drug therapy.

Original languageEnglish (US)
Pages (from-to)2037-2043
Number of pages7
JournalCirculation
Volume95
Issue number8
DOIs
StatePublished - Apr 15 1997

Keywords

  • coronary disease
  • drugs
  • electrocardiography
  • prognosis
  • revascularization
  • survival

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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