ANGINAL STATUS AND PREDICTION OF CARDIAC EVENTS IN PATIENTS ENROLLED IN THE ASYMPTOMATIC CARDIAC ISCHEMIA PILOT (ACIP) STUDY

We hypothesized that among the patients enrolled in the Asymptomatic C ardiac Ischemia pilot (ACIP) trial, those who reported angina either w ithin the previous 6 weeks or experienced angina during ambulatory ele ctrocardiographic (EGG) monitoring during activities of daily life or during stress testing would be more likely to experience an adverse ca rdiac event within a year than those who did not experience angina. Of the 558 patients enrolled in ACIP, 325 (58.2%) reported angina in the previous 6 weeks, 300 (53.8%) had stress-induced angina, and 63 (11.3 %) reported angina during activities of daily life associated with ST- segment changes on the 48-hour ambulatory electrocardiogram. Some pati ents had >1 of these angina symptoms and thus 8 angina status categori es were identified. Adverse cardiac events were defined as death, nonf atal myocardial infarction (MI), or hospitalization for ischemic event s, which included revascularization not specified by the ACIP protocol . One hundred and sixty-seven patients (29.9%) were asymptomatic (i.e. , they never had angina) by our defined criteria. Three hundred ninety -one patients (70.1%) were symptomatic. Symptomatic patients held a hi gher incidence of death, MI, or hospitalization for ischemic events (1 5.3% symptomatic vs 7.8% asymptomatic, p = 0.016). History of angina w ithin 6 weeks before randomization was predictive of death, MI, or hos pitalization for ischemic event (p = 0.007). This finding was due to a large difference in the need for hospitalizations which would be expe cted to be driven by the presence of angina. By contrast, angina durin g ambulatory electrocardiogram or stress test was not predictive of an adverse cardiac event. The asymptomatic status of coronary disease pa tients who have objective documentation of ischemia is not uniformly d efined and many different categories can be identified. In this popula tion of patients with proven coronary artery disease and myocardial is chemia, a history of angina in the previous 6 weeks was a good predict or of an adverse event occurring in the next year. (C) 1997 by Excerpt a Medica, Inc.