TY - JOUR
T1 - Effects of treatment strategies to suppress ischemia in patients with coronary artery disease
T2 - 12-Week results of the Asymptomatic Cardiac Ischemia Pilot (ACIP) study
AU - Knatterud, Genell L.
AU - Bourassa, Martial G.
AU - Pepine, Carl J.
AU - Geller, Nancy L.
AU - Sopko, George
AU - Chaitman, Bernard R.
AU - Pratt, Craig
AU - Stone, Peter H.
AU - Davies, Richard F.
AU - Rogers, William J.
AU - Deanfield, John E.
AU - Goldberg, A. David
AU - Ouyang, Pamela
AU - Mueller, Hiltrud
AU - Sharaf, Barry
AU - Day, Philip
AU - Selwyn, Andrew P.
AU - Conti, C. Richard
N1 - Funding Information:
This study was funded by the National Heart, Lung, and Blood Institute, Cardiac Diseases Branch, Division of Heart an? Vascular Diseases, National Institutes of Health, Bethesda, Maryland, by research contracts HV-90-07, NV-90-08, HV-91-05 to HV-91-14. Study medications and placebo were donated by Zeneca Pharmaceuticals Group, Wilmington, Delaware; Marion-Merrell Dow, Kansas City, Missouri; and Pfizer. New York, New York. Support for electrocardiographic data collection was provided in part by Applied Cardiac Systems, Laguna Hills, California; Marquette Electronics, Milwaukee, Wisconsin; and Quinton Instiumerrts. Seattle, Washington. Some centers had partial support from General Clinical Research Center grants. *A list of participating centers and investigators appears in reference I. Manuscript received January 19, 1994; revised manuscript received April 8, I Dr. Carl J. Pepine, University of Florida College of Medicine, Division of Cardiovascular Medicine, P.O. Box 100277. Gainesville, Florida 32610-0277. Address f&r,-: ACJP Clinical Coordinating Center, Maryland Medical Research Institute, 600 Wyndhurst Avenue, Baltimore, Maryland 21210.
PY - 1994/7
Y1 - 1994/7
N2 - Objectives. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was initiated to determine the feasibility of a large trial in evaluating the effects of treatment of ischemia on outcome (mortality and myocardial infarction). The study was designed to examine the effects of medical treatment to control angina compared with treatment strategies guided by ambulatory electrocardiographic (ECG) ischemia or coronary anatomy. Background. Treatments to suppress ischemia (asymptomatic and symptomatic) have not been evaluated in a large prospective, randomized trial. Before undertaking such a trial, issues about recruitment and treatment strategies must be addressed. Methods. The 618 enrolled patients had coronary artery disease suitable for revascularization, ischemia on stress test and asymptomatic ischemia on ambulatory ECG. Patients were assigned randomly to one of three treatment strategies: 1) angina-guided medical strategy with titration of anti-ischemic medication to relieve angina (angina-guided strategy); 2) angina-guided plus ambulatory ECG ischemia-guided medical strategy with titration of anti-ischemic medication to eliminate both angina and ambulatory ECG ischemia (ischemia-guided strategy); and 3) revascularization by angioplasty or bypass surgery (revascularization strategy). Results. Ambulatory ECG ischemia was no longer present at the week 12 visit in 39% of patients assigned to the angina-guided strategy, 41% of patients assigned to the ischemia-guided strategy and 55% of patients assigned to the revascularization strategy. All strategies reduced the median number of episodes and total duration of ST segment depression during follow-up ambulatory ECG monitoring. Revascularization was the most effective strategy. Treadmill test results were concordant with those of ambulatory ECG monitoring, lor most patients in the two medical strategies, angina was controlled with low to moderate doses of anti-ischemic medication, and the majority of patients (65%) in the revascularization strategy did not require medication for angina. Conclusions. This pilot study demonstrated that cardiac ischemia can be suppressed in 40% to 55% of patients with either low or moderate doses of medication or revascularization and that a large trial is feasible.
AB - Objectives. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was initiated to determine the feasibility of a large trial in evaluating the effects of treatment of ischemia on outcome (mortality and myocardial infarction). The study was designed to examine the effects of medical treatment to control angina compared with treatment strategies guided by ambulatory electrocardiographic (ECG) ischemia or coronary anatomy. Background. Treatments to suppress ischemia (asymptomatic and symptomatic) have not been evaluated in a large prospective, randomized trial. Before undertaking such a trial, issues about recruitment and treatment strategies must be addressed. Methods. The 618 enrolled patients had coronary artery disease suitable for revascularization, ischemia on stress test and asymptomatic ischemia on ambulatory ECG. Patients were assigned randomly to one of three treatment strategies: 1) angina-guided medical strategy with titration of anti-ischemic medication to relieve angina (angina-guided strategy); 2) angina-guided plus ambulatory ECG ischemia-guided medical strategy with titration of anti-ischemic medication to eliminate both angina and ambulatory ECG ischemia (ischemia-guided strategy); and 3) revascularization by angioplasty or bypass surgery (revascularization strategy). Results. Ambulatory ECG ischemia was no longer present at the week 12 visit in 39% of patients assigned to the angina-guided strategy, 41% of patients assigned to the ischemia-guided strategy and 55% of patients assigned to the revascularization strategy. All strategies reduced the median number of episodes and total duration of ST segment depression during follow-up ambulatory ECG monitoring. Revascularization was the most effective strategy. Treadmill test results were concordant with those of ambulatory ECG monitoring, lor most patients in the two medical strategies, angina was controlled with low to moderate doses of anti-ischemic medication, and the majority of patients (65%) in the revascularization strategy did not require medication for angina. Conclusions. This pilot study demonstrated that cardiac ischemia can be suppressed in 40% to 55% of patients with either low or moderate doses of medication or revascularization and that a large trial is feasible.
UR - http://www.scopus.com/inward/record.url?scp=0028337131&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0028337131&partnerID=8YFLogxK
U2 - 10.1016/0735-1097(94)90535-5
DO - 10.1016/0735-1097(94)90535-5
M3 - Article
C2 - 8006252
AN - SCOPUS:0028337131
SN - 0735-1097
VL - 24
SP - 11
EP - 20
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -