EFFECTS OF TREATMENT STRATEGIES TO SUPPRESS ISCHEMIA IN PATIENTS WITHCORONARY-ARTERY DISEASE - 12-WEEK RESULTS OF THE ASYMPTOMATIC CARDIACISCHEMIA PILOT (ACIP) STUDY

Objectives. The Asymptomatic Cardiac Ischemia Pilot (ACIP) study was i nitiated to determine the feasibility of a large trial in evaluating t he effects of treatment of ischemia on outcome (mortality and myocardi al infarction). The study was designed to examine the effects of medic al treatment to control angina compared with treatment strategies guid ed by ambulatory electrocardiographic (ECG) ischemia or coronary anato my. Background. Treatments to suppress ischemia (asymptomatic and symp tomatic) have not been evaluated in a large prospective, randomized tr ial. Before undertaking such a trial, issues about recruitment and tre atment strategies must be addressed. Methods. The 618 enrolled patient s 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 ambula tory ECG ischemia-guided medical strategy with titration of anti-ische mic medication to eliminate both angina and ambulatory ECG ischemia (i schemia-guided strategy); and 3) revascularization by angioplasty or b ypass surgery (revascularization strategy). Results. Ambulatory ECG is chemia was no longer present at the week 12 visit in 39% of patients a ssigned to the angina-guided strategy, 41% of patients assigned to the ischemia-guided strategy and 55% of patients assigned to the revascul arization strategy. All strategies reduced the median number of episod es and total duration of ST segment depression during follow up ambula tory ECG monitoring. Revascularization was the most effective strategy . Treadmill test results were concordant with those of ambulatory ECG monitoring. For most patients in the two medical strategies, angina wa s controlled with low to moderate doses of anti-ischemic medication, a nd the majority of patients (65%) in the revascularization strategy di d not require medication for angina. Conclusions. This pilot study dem onstrated that cardiac ischemia can be suppressed in 40% to 55% of pat ients with either low or moderate doses of medication or revasculariza tion and that a large trial is feasible.