Detailed Angiographic Analysis of Patients With Ambulatory Electrocardiographic Ischemia: Results From the Asymptomatic Cardiac Ischemi Pilot (ACIP) Study Angiographic Core Laboratory

Objectives. The purpose of this Asymptomatic Cardiac Ischemi Pilot (ACIP) dat bank study was to characterize angiographic features of coronary pathology of patients enrolled in the ACIP study. Background. Ischemi during ambulatory electrocardiographic (AECG) monitoring is associated with increased morbidity and mortality. Reports relating AECG ischemi to severity or complexity of coronary artery disease are few in number and small in size and have produced conflicting results. Methods. Coronary angiograms from patients with asymptomatic AECG ischemi enrolled in the ACIP study were reviewed at central core laboratory. Quantitative measurement of percent stenosis and Thrombolysis in Myocardial Infarction flow grades were used to assess the severity of coronary artery disease. Lesions were also evaluated for the presence of intracoronary thrombus, ulceration and lumen contour as indicators of stenosis complexity. In addition, comparisons were made with 27 patients screened for the ACIP study, but who were found ineligible because they did not have AECG ischemi on 48-h Holter monitoring. Results. total of 329 (75%) of 439 patients with AECG ischemi had multivessel coronary artery disease. Proximal stenoses ≥50% diameter reduction were common in patients with AECG ischemi (62.2%), as were proximal stenoses ≥70% (38.7%). Features suggesting complex plaque were found in 50.1% of patients with AECG ischemia. Conclusions. Multivessel coronary artery disease, severe proximal stenoses and features of complex plaque were observed frequently in patients who exhibited AECG ischemia. The presence of severe and complex coronary artery disease may explain, in part, the increased risk for adverse outcome associated with ischemi during activities of daily life.