Prognostic significance of myocardial ischemia detected by ambulatory electrocardiography, exercise treadmill testing, and electrocardiogram at rest to predict cardiac events by one year (The Asymptomatic Cardiac Ischemia Pilot [ACIP] study)

Peter H. Stone, Bernard R. Chaitman, Sandra Forman, Thomas C. Andrews, Vera Bittner, Martial G. Bourassa, Richard F. Davies, John E. Deanfield, William Frishman, A. David Goldberg, Gail MacCallum, Pamela Ouyang, Carl J. Pepine, Craig M. Pratt, Barry Sharaf, Richard Steingart, Genell L. Knatterud, George Sopko, C. Richard Conti

Research output: Contribution to journalArticle

Abstract

Myocardial ischemia identified by ambulatory electrocardiography (AECG), exercising treadmill testing, (ETT), or 12-lead electrocardiogram at rest is associated with an adverse prognosis, but the effect of improving these ischemic manifestations by treatment on outcome is unknown. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was a National Heart, Lung, and Blood Institute funded study to determine the feasibility of conducting a large- scale prognosis study and to assess the effect of 3 treatment strategies (angina-guided strategy, AECG ischemia-guided strategy, and revascularization strategy) in reducing the manifestations of ischemia as indicated by AECG and ETT. The study cohort for this database study consisted of 496 randomized patients who performed the AECG, ETT, and 12-lead electrocardiogram at rest at bath the qualifying and week 12 visits. The effect of modifying ischemia by treatment on the incidence of cardiac events (death, myocardial infarction, coronary revascularization procedure, or hospitalization for an ischemic event) at 1 year was examined. In the 2 medical treatment groups (n = 328) there was an association between the number of ambulatory electrocardiographic ischemic episodes at the qualifying visit and combined cardiac events at 1 year (p = 0.003). In the AECG ischemia-guided patients there was a trend associating greater reduction in the number of ambulatory electrocardiographic ischemia episodes with a reduced incidence of combined cardiac events (r = -0.15, p = 0.06). In the revascularization strategy patients this association was absent. In the medical treatment patients the exercise duration on the baseline ETT was inversely associated with an adverse prognosis (p = 0.02). The medical treatment strategies only slightly improved the exercise time and the exercise duration remained of prognostic significance. In the revascularization group strategy patients this association was absent. Thus, myocardial ischemia detected by AECG end an abnormal ETT are each independently associated with an adverse cardiac outcome in patients subsequently treated medically.

Original languageEnglish (US)
Pages (from-to)1395-1401
Number of pages7
JournalThe American Journal of Cardiology
Volume80
Issue number11
DOIs
StatePublished - Dec 1 1997

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Ambulatory Electrocardiography
Myocardial Ischemia
Electrocardiography
Ischemia
Exercise
National Heart, Lung, and Blood Institute (U.S.)
Therapeutics
Incidence
Baths
Hospitalization
Cohort Studies
Myocardial Infarction
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Prognostic significance of myocardial ischemia detected by ambulatory electrocardiography, exercise treadmill testing, and electrocardiogram at rest to predict cardiac events by one year (The Asymptomatic Cardiac Ischemia Pilot [ACIP] study). / Stone, Peter H.; Chaitman, Bernard R.; Forman, Sandra; Andrews, Thomas C.; Bittner, Vera; Bourassa, Martial G.; Davies, Richard F.; Deanfield, John E.; Frishman, William; Goldberg, A. David; MacCallum, Gail; Ouyang, Pamela; Pepine, Carl J.; Pratt, Craig M.; Sharaf, Barry; Steingart, Richard; Knatterud, Genell L.; Sopko, George; Conti, C. Richard.

In: The American Journal of Cardiology, Vol. 80, No. 11, 01.12.1997, p. 1395-1401.

Research output: Contribution to journalArticle

Stone, PH, Chaitman, BR, Forman, S, Andrews, TC, Bittner, V, Bourassa, MG, Davies, RF, Deanfield, JE, Frishman, W, Goldberg, AD, MacCallum, G, Ouyang, P, Pepine, CJ, Pratt, CM, Sharaf, B, Steingart, R, Knatterud, GL, Sopko, G & Conti, CR 1997, 'Prognostic significance of myocardial ischemia detected by ambulatory electrocardiography, exercise treadmill testing, and electrocardiogram at rest to predict cardiac events by one year (The Asymptomatic Cardiac Ischemia Pilot [ACIP] study)', The American Journal of Cardiology, vol. 80, no. 11, pp. 1395-1401. https://doi.org/10.1016/S0002-9149(97)00706-6
Stone, Peter H. ; Chaitman, Bernard R. ; Forman, Sandra ; Andrews, Thomas C. ; Bittner, Vera ; Bourassa, Martial G. ; Davies, Richard F. ; Deanfield, John E. ; Frishman, William ; Goldberg, A. David ; MacCallum, Gail ; Ouyang, Pamela ; Pepine, Carl J. ; Pratt, Craig M. ; Sharaf, Barry ; Steingart, Richard ; Knatterud, Genell L. ; Sopko, George ; Conti, C. Richard. / Prognostic significance of myocardial ischemia detected by ambulatory electrocardiography, exercise treadmill testing, and electrocardiogram at rest to predict cardiac events by one year (The Asymptomatic Cardiac Ischemia Pilot [ACIP] study). In: The American Journal of Cardiology. 1997 ; Vol. 80, No. 11. pp. 1395-1401.
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abstract = "Myocardial ischemia identified by ambulatory electrocardiography (AECG), exercising treadmill testing, (ETT), or 12-lead electrocardiogram at rest is associated with an adverse prognosis, but the effect of improving these ischemic manifestations by treatment on outcome is unknown. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was a National Heart, Lung, and Blood Institute funded study to determine the feasibility of conducting a large- scale prognosis study and to assess the effect of 3 treatment strategies (angina-guided strategy, AECG ischemia-guided strategy, and revascularization strategy) in reducing the manifestations of ischemia as indicated by AECG and ETT. The study cohort for this database study consisted of 496 randomized patients who performed the AECG, ETT, and 12-lead electrocardiogram at rest at bath the qualifying and week 12 visits. The effect of modifying ischemia by treatment on the incidence of cardiac events (death, myocardial infarction, coronary revascularization procedure, or hospitalization for an ischemic event) at 1 year was examined. In the 2 medical treatment groups (n = 328) there was an association between the number of ambulatory electrocardiographic ischemic episodes at the qualifying visit and combined cardiac events at 1 year (p = 0.003). In the AECG ischemia-guided patients there was a trend associating greater reduction in the number of ambulatory electrocardiographic ischemia episodes with a reduced incidence of combined cardiac events (r = -0.15, p = 0.06). In the revascularization strategy patients this association was absent. In the medical treatment patients the exercise duration on the baseline ETT was inversely associated with an adverse prognosis (p = 0.02). The medical treatment strategies only slightly improved the exercise time and the exercise duration remained of prognostic significance. In the revascularization group strategy patients this association was absent. Thus, myocardial ischemia detected by AECG end an abnormal ETT are each independently associated with an adverse cardiac outcome in patients subsequently treated medically.",
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AU - Chaitman, Bernard R.

AU - Forman, Sandra

AU - Andrews, Thomas C.

AU - Bittner, Vera

AU - Bourassa, Martial G.

AU - Davies, Richard F.

AU - Deanfield, John E.

AU - Frishman, William

AU - Goldberg, A. David

AU - MacCallum, Gail

AU - Ouyang, Pamela

AU - Pepine, Carl J.

AU - Pratt, Craig M.

AU - Sharaf, Barry

AU - Steingart, Richard

AU - Knatterud, Genell L.

AU - Sopko, George

AU - Conti, C. Richard

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N2 - Myocardial ischemia identified by ambulatory electrocardiography (AECG), exercising treadmill testing, (ETT), or 12-lead electrocardiogram at rest is associated with an adverse prognosis, but the effect of improving these ischemic manifestations by treatment on outcome is unknown. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was a National Heart, Lung, and Blood Institute funded study to determine the feasibility of conducting a large- scale prognosis study and to assess the effect of 3 treatment strategies (angina-guided strategy, AECG ischemia-guided strategy, and revascularization strategy) in reducing the manifestations of ischemia as indicated by AECG and ETT. The study cohort for this database study consisted of 496 randomized patients who performed the AECG, ETT, and 12-lead electrocardiogram at rest at bath the qualifying and week 12 visits. The effect of modifying ischemia by treatment on the incidence of cardiac events (death, myocardial infarction, coronary revascularization procedure, or hospitalization for an ischemic event) at 1 year was examined. In the 2 medical treatment groups (n = 328) there was an association between the number of ambulatory electrocardiographic ischemic episodes at the qualifying visit and combined cardiac events at 1 year (p = 0.003). In the AECG ischemia-guided patients there was a trend associating greater reduction in the number of ambulatory electrocardiographic ischemia episodes with a reduced incidence of combined cardiac events (r = -0.15, p = 0.06). In the revascularization strategy patients this association was absent. In the medical treatment patients the exercise duration on the baseline ETT was inversely associated with an adverse prognosis (p = 0.02). The medical treatment strategies only slightly improved the exercise time and the exercise duration remained of prognostic significance. In the revascularization group strategy patients this association was absent. Thus, myocardial ischemia detected by AECG end an abnormal ETT are each independently associated with an adverse cardiac outcome in patients subsequently treated medically.

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