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A Detailed Angiographic Analysis of Patients With Ambulatory Electrocardiographic Ischemia: Results From the Asymptomatic Cardiac Ischemia Pilot (ACIP) Study Angiographic Core Laboratoryfn1fn1 This study was funded by the National Heart, Lung, and Blood Institute, Cardiac Diseases Branch, Division of Heart and Vascular Diseases, National Institutes of Health, Bethesda, Maryland, by Research Contracts HV-90-07, HV-90-08, HV-91-05 to HV-91-14. Study medications and placebo were donated by Zeneca Pharmaceuticals Group, Wilmington, Delaware; Marion-Merrell Dow, Kansas City, Missouri; and Pfizer, New York, New York. Support for electrocardiographic data collection was provided in part by Applied Cardiac Systems, Laguna Hills, California; Marquette Electronics and Mortara Instrument, Milwaukee, Wisconsin; and Quinton Instruments, Seattle, Washington. Some centers had partial support from General Clinical Research Center grants.

Journal of the American College of Cardiology
Publication Date
DOI: 10.1016/s0735-1097(96)00444-5
  • Coronary Artery Disease
  • Biology
  • Medicine


Abstract Objectives. The purpose of this Asymptomatic Cardiac Ischemia Pilot (ACIP) data bank study was to characterize angiographic features of coronary pathology of patients enrolled in the ACIP study. Background. Ischemia during ambulatory electrocardiographic (AECG) monitoring is associated with increased morbidity and mortality. Reports relating AECG ischemia 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 ischemia enrolled in the ACIP study were reviewed at a 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 ischemia on 48-h Holter monitoring. Results. A total of 329 (75%) of 439 patients with AECG ischemia had multivessel coronary artery disease. Proximal stenoses ≥50% diameter reduction were common in patients with AECG ischemia (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 ischemia during activities of daily life. (J Am Coll Cardiol 1997;29:78–84)>

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