Relation Between Clinical, Angiographic and Ischemic Findings at Baseline and Ischemia-Related Adverse Outcomes at 1 Year in the Asymptomatic Cardiac Ischemi Pilot Study

Objectives. We attempted to investigate the relation between patient characteristics and adverse outcome in patients with ischemi and clinically stable coronary artery disease (CAD). Background. Evidence suggests that cardiac ischemia, detected by exercise stress testing (ETT) and ambulatory electrocardiographic (AECG) monitoring during daily living, identifies subgroup of patients at increased risk for adverse outcome, but the relation between these ischemi findings and clinical and angiographic characteristics is largely unknown. Methods. We examined the relation between clinical, angiographic and ischemi characteristics at entry with adverse outcome observed at 1 year in the 558 patients enrolled in the Asymptomatic Cardiac Ischemi Pilot (ACIP) study. Results. By the 12-month visit 13.1% of patients had an ischemia-related adverse clinical outcome that included death, nonfatal myocardial infarction or an ischemia-related hospital admission. Multivariate analysis 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 revascularization (as opposed to an initial medical treatment strategy) showed trend (OR 0.56, 99% CI 0.26 to 1.2, p = 0.05). None of the other baseline clinical, exercise or angiographic variables examined provided additional information relative to adverse outcome. Conclusions. Determinants of adverse outcome, among clinically stable patients with CAD and ischemi induced by stress and daily life were magnitude of AECG ischemi before treatment and, possibly, initial treatment assignment. Among the many other characteristics examined, including age, symptom status and angiographic and exercise variables, none contributed additional independent prognostic information. These two simple variables, which may be modifiable, need further study in larger trial.