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(Circulation. 1996;94:1537-1544.)
© 1996 American Heart Association, Inc.

Articles

Asymptomatic Cardiac Ischemia Pilot (ACIP) Study

Relationship Between Exercise-Induced and Ambulatory Ischemia in Patients With Stable Coronary Disease

Peter H. Stone, MD; Bernard R. Chaitman, MD; Robert P. McMahon, PhD; Thomas C. Andrews, MD; Gail MacCallum, BS; Barry Sharaf, MD; William Frishman, MD; John E. Deanfield, MD; George Sopko, MD; Craig Pratt, MD; A. David Goldberg, MD; William J. Rogers, MD; James Hill, MD; Michael Proschan, PhD; Carl J. Pepine, MD; Martial G. Bourassa, MD; C. Richard Conti, MD; for the ACIP Investigators

Cardiovascular Division (P.H.S., G.M.), Brigham and Women's Hospital, Boston, Mass; Division of Cardiology, Department of Internal Medicine (B.R.C.), St Louis (Mo) University Medical Center; ACIP Coordinating Center, Maryland Medical Research Institute (R.P.M.), Baltimore; PSMC/Department of Cardiology, Wilford Hall USAF Medical Center (AETC) (T.C.A.), Lackland AFB, Tex; Rhode Island Hospital (B.S.), Providence; Albert Einstein Hospital (W.F.), Bronx, NY; Cardiology Department (J.E.D.), St Bartholomew's Hospital, London, England; National Institutes of Health (G.S., M.P.), Bethesda, Md; Baylor College of Medicine, Section of Cardiology (C.P.), Houston, Tex; Henry Ford Hospital (A.D.G.), Detroit, Mich; University of Alabama Medical Center (W.J.R.), Birmingham; Department of Cardiology (J.H., C.R.C.), University of Florida, Gainesville; Veterans Administration Medical Center, Cardiology Section (C.J.P.), Gainesville, Fla; and Institut de Cardiologie de Montreal (M.G.B.), Quebec, Canada.

Correspondence to Peter H. Stone, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Reprint requests to ACIP Clinical Coordinating Center, Maryland Medical Research Institute, Baltimore, MD 21210.

Background We investigated whether the presence and frequency of asymptomatic ischemic episodes recorded during ambulatory ECG (AECG) monitoring could be predicted on the basis of clinical characteristics or exercise treadmill test (ETT) performance in patients with stable coronary disease and whether the estimate of ischemia severity was similar between the AECG and ETT.

Methods and Results Patients screened for the Asymptomatic Cardiac Ischemia Pilot (ACIP) study were selected for the current analysis if data were available from 48-hour AECG monitoring as well as from an ETT during which the patient developed 1-mm ST-segment depression. Exercise ECG data were available for 143 of the 910 patients without ischemic episodes and for 659 of the 910 patients with ischemic episodes during AECG monitoring. Angina was more frequent among patients with ambulatory ischemic episodes than among patients without such ischemia (P<.001). Patients with AECG ischemia had a consistently more marked ischemic response on the ETT than patients without AECG ischemia; patients likely to have AECG ischemia could be predicted on the basis of ETT performance characteristics. However, the correlation coefficients between the severity of ischemia estimated by ETT and by AECG were small.

Conclusions There are significant relations between ischemia detected by AECG monitoring and by ETT, but the relations are limited, indicating that the two tests are not redundant to characterize coronary patients. A larger study investigating the prognostic significance of the ischemia identified by each modality, with follow-up for clinical events, will be necessary to determine the most appropriate methods to evaluate patients with stable coronary disease.

Key Words: ischemia • electrocardiography • coronary disease • prognosis • trials

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