Factors influencing clinical outcomes after revascularization in the asymptomatic cardiac ischemia pilot (ACIP). ACIP Study Group.
OBJECTIVE
The Asymptomatic Cardiac Ischemia Pilot is the first randomized trial where revascularization involved choice of either coronary bypass or angioplasty used in an early or a delayed symptom-driven approach. One-year outcomes were favorable (reduced recurrent ischemia and adverse outcomes) for an early revascularization strategy (within 4 weeks), compared with an early medical strategy when revascularization was delayed until symptom-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 patients with stress-induced and daily life ischemia who underwent revascularization. Characteristics associated with clinical outcomes occurring within the year following revascularization were examined using Cox regression analysis.


RESULTS
A total of 262 patients received revascularization; 170 in the early approach and 92 in the delayed symptom-driven approach. Thirty-three patients had adverse outcomes (death, nonfatal myocardial infarction, or repeat revascularization) during 1-year follow-up. The most important independent predictor of improved outcome during the follow-up year was attempted revascularization of > or = 66% of vessels with significant stenosis for the early (risk ratio [RR] 0.25, 95% confidence interval [CI] 0.09-0.67) and the delayed (RR 0.21, CI 0.08-0.58) approaches. Factors such as age, stress test results, and coronary angiographic findings did not predict clinical outcome.


CONCLUSIONS
Our findings are important in the planning of a large trial with longer follow-up.
Pepine
C J
CJ
University of Florida, College of Medicine, Division of Cardiovascular Medicine, Gainesville 32610-0277, USA.
Bourassa
M G
MG
Chaitman
B R
BR
Davies
R F
RF
Kerensky
R A
RA
Sharaf
B
B
Knatterud
G L
GL
Forman
S A
SA
Pratt
C M
CM
Staples
E D
ED
Sopko
G
G
Conti
C R
CR
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010865:Pilot Projects; D012044:Regression Analysis; D019233:Retreatment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome