(a) Pepine CJ, Geller NL, Knatterud G et al
(b) Knatterud GL, Bourassa M, Pepine CJ et al
(c) Rogers WJ, Bourassa M, Andrews TC, Bertolet BD, Blumenthal RS, Chaitman BR, Forman SA, Geller NL, Goldberg AD, Habib GB, Masters RG, Moisa RB,
Mueller H, Pearce DJ, Pepine CJ, Sopko G, Steingart RM, Stone PH, Knatterud GL, Conti CR
(d) Bourassa M, Knatterud GL, Pepine CJ, Sopko G, Rogers WJ, Geller NL, Dyrda I, Forman SA, Chaitman BR, Sharaf B, Davies RF, Conti CR
(e) Pratt CM, McMahon RP, Goldstein S, Pepine CJ, Andrews TC, Dyrda I, Frishman WH, Geller NL, Hill JA, Morgan NA, Stone PH, Knatterud GL, Sopko G, Conti CR
(f) Davies RF, Goldberg AD, Forman S, Pepine CJ, Knatterud GL, Geller N, Sopko G, Pratt C, Deanfield J, Conti CR

(a) The Asymptomatic Cardiac Ischemia Pilot (ACIP) Study: design of a randomized clinical trial, baseline data and implications for a long-term outcome trial
(b) Effects of treatment strategies to suppress ischemia in patients with coronary artery disease: 12-week results of the Asymptomatic Cardiac Ischemia Pilot (ACIP) study
(c) Asymptomatic Cardiac Ischemia Pilot (ACIP) study: outcome at 1 year for patients with asymptomatic cardiac ischemia randomized to medical therapy or revascularization
(d) Asymptomatic Cardiac Ischemia Pilot (ACIP) study. Improvement of cardiac ischemia at 1 year after PTCA and CABG
(e) Comparison of subgroup assigned to medical regimens used to suppress cardiac ischemia (the Asymptomatic Cardiac Ischemia Pilot (ACIP) study)
(f) Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up. Outcome of patients randomized to initial strategies of medical therapy versus revascularization

(a) J Am Coll Cardiol 1994;24:1-10
(b) J Am Coll Cardiol 1994;24:11-20
(c) J Am Coll Cardiol 1995;26:594-605
(d) Circulation 1995;92 Suppl II:II-1-7
(e) Am J Cardiol 1996;77:1302-9
(f) Circulation 1997;95:2037-43

Silent ischaemia

To compare the 12 weeks’ anti-ischaemic effect of angina-directed medical therapy, angina plus ambulatory ECG-directed medical therapy, and revascularisation

Randomised

12 weeks and 1 year

618 patients (204 ‘control’, 202 ischaemia-guided therapy, 212 revascularisation). Patients must have at least 1 major coronary artery narrowing ≥ 50%, stress-related ischaemia, 1 episode or more of silent ischaemia on a 48-h ambulatory ECG

‘Control’: antianginal therapy to relieve angina plus blinded placebo. Medical, ischaemia-guided: antianginal therapy to relieve angina and ischaemia on 48-h ECG. Revascularisation: PTCA or CABG. If necessary blinded antianginal therapy

At 12 weeks, ambulatory ECG ischaemia was no longer present in 39% of patients assigned to the angina-guided strategy, 41% of patients assigned to the ischaemia-guided strategy and 55% of patients assigned to the revascularisation strategy. All strategies reduced the number of ischaemic episodes and total duration of ST-segment depression during follow-up ambulatory ECG monitoring. For most patients in the two medical strategies, angina was controlled with low to moderate doses of anti-ischaemic medication. Following revascularisation, 65% of patients did not require angina medication. Despite more severe coronary disease and more ischaemic episodes at baseline, ischaemia was significantly improved in the CABG patients compared to the PTCA patients, and significantly fewer patients had angina (90% vs 68%, p = 0.001); these differences were maintained to 1 year. At 1 year, mortality rate was 4.4% in the angina-guided group, 1.6% in the ischaemia-guided group, 0% in the revascularisation group (overall p = 0.004; angina-guided vs revascularisation, p = 0.003). The revascularisation group had significantly fewer hospital admissions and non-protocol revascularisations at 1 year, but the frequency of MI, unstable angina, stroke and congestive heart failure was not different between the groups. The incidence of death, MI, non-protocol revascularisation, or hospital admission at 1 year was 32% (angina-guided), 31% (ischaemia-guided) and 18% (revascularisation) (p = 0.003). 2 years after randomisation the total mortality had increased to 6.6% in the angina-guided group, 4.4% in the ischaemia-guided group, and 1.1% in the group with revascularisation strategy