RELATION BETWEEN CLINICAL, ANGIOGRAPHIC AND ISCHEMIC FINDINGS AT BASE-LINE AND ISCHEMIA-RELATED ADVERSE OUTCOMES AT 1 YEAR IN THE ASYMPTOMATIC CARDIAC ISCHEMIA PILOT-STUDY

Objectives. We attempted to investigate the relation between patient c haracteristics and adverse outcome in patients with ischemia and clini cally stable coronary artery disease (CAD). Background. Evidence sugge sts that cardiac ischemia, detected by exercise stress testing (ETT) a nd ambulatory electrocardiographic (AECG) monitoring during daily livi ng, identifies a subgroup of patients at increased risk for adverse ou tcome, but the relation between these ischemia findings and clinical a nd angiographic characteristics is largely unknown. Methods. We examin ed the relation between clinical, angiographic and ischemia characteri stics at entry with adverse out come observed at 1 year in the 558 pat ients enrolled in the Asymptomatic Cardiac Ischemia Pilot (ACIP) study . Results. By the 12-month visit 13.1% of patients had an ischemia-rel ated adverse clinical outcome that included death, nonfatal myocardial infarction or an ischemia-related hospital admission. Multivariate an alysis identified only the number of AECG ischemic episodes at entry ( odds ratio [OR] 1.06, 99% confidence interval [CI] 1.01 to 1.12, p = 0 .002) as an independent predictor of outcome. Assignment to revascular ization (as opposed to an initial medical treatment strategy) showed a trend (OR 0.56, 99% CI 0.26 to 1.2, p = 0.05). None of the other base line clinical, exercise or angiographic variables examined provided ad ditional information relative to adverse outcome. Conclusions. Determi nants of adverse outcome, among clinically stable patients with CAD an d ischemia induced by stress and daily life were magnitude of AECG isc hemia before treatment and, possibly, initial treatment assignment, Am ong the many other characteristics examined, including age, symptom st atus and angiographic and exercise variables, none contributed additio nal independent prognostic information. These two simple variables, wh ich may be modifiable, need further study in a larger trial. (C) 1997 by the American College of Cardiology.