Tags

Type your tag names separated by a space and hit enter

Asymptomatic Cardiac Ischemia Pilot (ACIP) study: effects of coronary angioplasty and coronary artery bypass graft surgery on recurrent angina and ischemia. The ACIP investigators.
J Am Coll Cardiol. 1995 Sep; 26(3):606-14.JACC

Abstract

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.

Authors+Show Affiliations

Montreal Heart Institute, Quebec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

7642849

Citation

Bourassa, M G., et al. "Asymptomatic Cardiac Ischemia Pilot (ACIP) Study: Effects of Coronary Angioplasty and Coronary Artery Bypass Graft Surgery On Recurrent Angina and Ischemia. the ACIP Investigators." Journal of the American College of Cardiology, vol. 26, no. 3, 1995, pp. 606-14.
Bourassa MG, Pepine CJ, Forman SA, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) study: effects of coronary angioplasty and coronary artery bypass graft surgery on recurrent angina and ischemia. The ACIP investigators. J Am Coll Cardiol. 1995;26(3):606-14.
Bourassa, M. G., Pepine, C. J., Forman, S. A., Rogers, W. J., Dyrda, I., Stone, P. H., Chaitman, B. R., Sharaf, B., Mahmarian, J., & Davies, R. F. (1995). Asymptomatic Cardiac Ischemia Pilot (ACIP) study: effects of coronary angioplasty and coronary artery bypass graft surgery on recurrent angina and ischemia. The ACIP investigators. Journal of the American College of Cardiology, 26(3), 606-14.
Bourassa MG, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) Study: Effects of Coronary Angioplasty and Coronary Artery Bypass Graft Surgery On Recurrent Angina and Ischemia. the ACIP Investigators. J Am Coll Cardiol. 1995;26(3):606-14. PubMed PMID: 7642849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymptomatic Cardiac Ischemia Pilot (ACIP) study: effects of coronary angioplasty and coronary artery bypass graft surgery on recurrent angina and ischemia. The ACIP investigators. A1 - Bourassa,M G, AU - Pepine,C J, AU - Forman,S A, AU - Rogers,W J, AU - Dyrda,I, AU - Stone,P H, AU - Chaitman,B R, AU - Sharaf,B, AU - Mahmarian,J, AU - Davies,R F, PY - 1995/9/1/pubmed PY - 1995/9/1/medline PY - 1995/9/1/entrez SP - 606 EP - 14 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 26 IS - 3 N2 - 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. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/7642849/Asymptomatic_Cardiac_Ischemia_Pilot__ACIP__study:_effects_of_coronary_angioplasty_and_coronary_artery_bypass_graft_surgery_on_recurrent_angina_and_ischemia__The_ACIP_investigators_ L2 - https://linkinghub.elsevier.com/retrieve/pii/073510979500005O DB - PRIME DP - Unbound Medicine ER -