ASYMPTOMATIC CARDIAC ISCHEMIA PILOT (ACIP) STUDY - RELATIONSHIP BETWEEN EXERCISE-INDUCED AND AMBULATORY ISCHEMIA IN PATIENTS WITH STABLE CORONARY-DISEASE

Background We investigated whether the presence and frequency of asymp tomatic ischemic episodes recorded during ambulatory ECG (AECG) monito ring could be predicted on the basis of clinical characteristics or ex ercise treadmill test (ETT) performance in patients with stable corona ry disease and whether the estimate of ischemia severity was similar b etween the AECG and ETT. Methods and Results Patients screened for the Asymptomatic Cardiac Ischemia Pilot (ACIP) study were selected for th e current analysis if data were available from 48-hour AECG monitoring as well as from an ETT during which the patient developed greater tha n or equal to 1-mm ST-segment depression. Exercise ECG data were avail able for 143 of the 910 patients without ischemic episodes and for 659 of the 910 patients with ischemic episodes during AECG monitoring. An gina was more frequent among patients with ambulatory ischemic episode s than among patients without such ischemia (P<.001). Patients with AE CG ischemia had a consistently more marked ischemic response on the ET T than patients without AECG ischemia; patients likely to have AECG is chemia could be predicted on the basis of ETT performance characterist ics. However, the correlation coefficients between the severity of isc hemia estimated by ETT and by AECG were small. Conclusions There are s ignificant relations between ischemia detected by AECG monitoring and by ETT, but the relations are limited, indicating that the two tests a re not redundant to characterize coronary patients. A larger study inv estigating the prognostic significance of the ischemia identified by e ach modality, with follow-up for clinical events, will be necessary to determine the most appropriate methods to evaluate patients with stab le coronary disease.