| Asymptomatic Cardiac Ischemia Pilot (ACIP) study: effects of coronary angioplasty and coronary artery bypass graft surgery on recurrent angina and ischemia. The ACIP investigators. | |
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MedLine Citation:
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PMID: 7642849 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The Asymptomatic Cardiac Ischemia Pilot (ACIP) study showed that revascularization is more effective than medical therapy in suppressing cardiac ischemia at 12 weeks. This report compares the relative efficacy of coronary angioplasty or coronary artery bypass graft surgery in suppressing ambulatory electrocardiographic (ECG) and treadmill exercise cardiac ischemia between 2 and 3 months after revascularization in the ACIP study. BACKGROUND: Previous studies have shown that coronary angioplasty and bypass surgery relieve angina early after the procedure in a high proportion of selected patients. However, alleviation of ischemia on the ambulatory ECG and treadmill exercise test have not been adequately studied prospectively after revascularization. METHODS: In patients randomly assigned to revascularization in the ACIP study, the choice of coronary angioplasty or bypass surgery was made by the clinical unit staff and the patient. RESULTS: Patients assigned to bypass surgery (n = 78) had more severe coronary disease (p = 0.001) and more ischemic episodes (p = 0.01) at baseline than those assigned to angioplasty (n = 92). Ambulatory ECG ischemia was no longer present 8 weeks after revascularization (12 weeks after enrollment) in 70% of the bypass surgery group versus 46% of the angioplasty group (p = 0.002). ST segment depression on the exercise ECG was no longer present in 46% of the bypass surgery group versus 23% of the angioplasty group (p = 0.005). Total exercise time in minutes on the treadmill exercise test increased by 2.4 min after bypass surgery and by 1.4 min after angioplasty (p = 0.02). Only 10% of the bypass surgery group versus 32% of the angioplasty group still reported angina in the 4 weeks before the 12-week visit (p = 0.001). CONCLUSIONS: Angina and ambulatory ECG ischemia are relieved in a high proportion of patients early after revascularization. However, ischemia can still be induced on the treadmill exercise test, albeit at higher levels of exercise, in many patients. Bypass surgery was superior to coronary angioplasty in suppressing cardiac ischemia despite the finding that patients who underwent bypass surgery had more severe coronary artery disease. |
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Authors:
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M G Bourassa; C J Pepine; S A Forman; W J Rogers; I Dyrda; P H Stone; B R Chaitman; B Sharaf; J Mahmarian; R F Davies |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 26 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1995 Sep |
Date Detail:
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Created Date: 1995-09-20 Completed Date: 1995-09-20 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 606-14 Citation Subset: AIM; IM |
Affiliation:
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Montreal Heart Institute, Quebec, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angina Pectoris
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diagnosis,
epidemiology,
therapy* Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects, statistics & numerical data Cardiovascular Agents / therapeutic use Combined Modality Therapy Coronary Artery Bypass* / adverse effects, statistics & numerical data Drug Therapy, Combination Electrocardiography, Ambulatory / statistics & numerical data Exercise Test / statistics & numerical data Female Follow-Up Studies Humans Male Middle Aged Myocardial Ischemia / diagnosis, epidemiology, therapy* Pilot Projects Prospective Studies Recurrence Remission Induction Time Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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HV-90-07/HV/NHLBI NIH HHS; HV-90-08/HV/NHLBI NIH HHS; HV-91-05/HV/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Cardiovascular Agents |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 1996 Apr;27(5):1315-6
[PMID:
8609359
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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