Factors influencing clinical outcomes after revascularization in the asymptomatic cardiac ischemia pilot (ACIP)

Background and Aim: The Asymptomatic Cardiac Ischemia Pilot is the first ra ndomized trial where revascularization involved choice of either coronary b ypass or angioplasty used in an early or a delayed symptom-driven approach. One-year outcomes were favorable (reduced recurrent ischemia and adverse o utcomes) for an early revascularization strategy (within 4 weeks), compared with an early medical strategy when revascularization was delayed until sy mptom-driven. This ancillary study examined variables influencing outcomes after these 2 revascularization approaches (early vs. delayed until symptom -driven). Methods: Participants were clinically stable coronary disease pat ients with stress-induced and daily life ischemia who underwent revasculari zation. Characteristics associated with clinical outcomes occurring within the year following revascularization were examined using Cox regression ana lysis. Results: A total of 262 patients received revascularization; 170 in the early approach and 92 in the delayed symptom-driven approach. Thirty-th ree patients had adverse outcomes (death, nonfatal myocardial infarction, o r repeat revascularization) during 1-year follow-up. The most important ind ependent predictor of improved outcome during the follow-up year was attemp ted revascularization of greater than or equal to 66% of vessels with signi ficant stenosis for the early (risk ratio [RR] 0.25, 95% confidence interva l [CI] 0.09-0.67) and the delayed (RR 0.21, CI 0.08-0.58) approaches. Facto rs such as age, stress test results, and coronary angiographic findings did not predict clinical outcome. Conclusions: Our findings are important in t he planning of a large trial with longer follow-up.