Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life. The Atenolol Silent Ischemia Study (ASIST)
Key result
Atenolol treatment improved 1-year event-free survival compared with placebo in patients with mild or no angina and daily life ischemia (RR 0.44; 95% CI 0.26-0.75; P=0.001).
Why the study?
Does atenolol improve event-free survival in asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery disease?
Population
306 asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery…
Comparison
Atenolol 100 mg/d vs Placebo
Design
RCT, randomized, double-blind
Follow-up
1 year
Authors
Discussion
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Implication
Supports atenolol in silent ischemia; confirms event-free survival benefit in this RCT population.
Study Design
Type
RCT (n=306)
Blinding
Double-blind
Randomization
randomized
Multicenter
Yes
Structured PICO
Does atenolol improve event-free survival in asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery disease?
P
Population
306 asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery disease, mild or no angina (Canadian Cardiovascular Society class I or II), abnormal exercise tests, and ischemia on ambulatory monitoring
I
Intervention
Atenolol 100 mg/d
C
Comparator
Placebo
O
Outcome
Event-free survival at 1 year (composite of death, resuscitated ventricular tachycardia/fibrillation, myocardial infarction, hospitalization for unstable angina, aggravation of angina, or revascularization)composite
Main Result
Effect estimate: RR 0.44 (95% CI 0.26-0.75)
p-value: p=0.001
Atenolol 100 mg/d reduces daily life ischemia and improves 1-year event-free survival in mildly symptomatic patients with coronary artery disease and silent ischemia.
Cite This Study
Pepine et al. (1994) conducted an RCT in Coronary artery disease with daily life silent ischemia (n=306). Atenolol vs. Placebo was evaluated on Event-free survival at 1 year (death, resuscitated ventricular tachycardia/fibrillation, myocardial infarction, hospitalization for unstable angina, aggravation of angina, or revascularization) (RR 0.44, 95% CI 0.26-0.75, p=0.001). Atenolol treatment improved 1-year event-free survival compared with placebo in patients with mild or no angina and daily life ischemia (RR 0.44; 95% CI 0.26-0.75; P=0.001).