What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Asymptomatic cardiac ischemia (n=466). Intervention: Asymptomatic AECG ischemia vs. No AECG ischemia. Primary outcome: Multivessel coronary artery disease.

What does this research mean for the field?

Asymptomatic ambulatory electrocardiographic ischemia is frequently associated with multivessel coronary artery disease, severe proximal stenoses, and complex plaque morphology. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to characterize the angiographic features of coronary pathology in patients with asymptomatic ambulatory electrocardiographic ischemia.

June 15, 2026Journal of the American College of Cardiology

A Detailed Angiographic Analysis of Patients With Ambulatory Electrocardiographic Ischemia: Results From the Asymptomatic Cardiac Ischemia Pilot (ACIP) Study Angiographic Core Laboratory fn1fn1This 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.

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Key result

Asymptomatic AECG ischemia links to multivessel CAD in ~75% of patients alongside complex plaque features.

n=466

Why the study?

Reports relating ambulatory electrocardiographic ischemia to the severity or complexity of coronary artery disease were few, small in size, and conflicting.

Population

439 patients with asymptomatic AECG ischemia and 27 screened patients without AECG ischemia

Comparison

Patients with AECG ischemia vs screened patients without AECG ischemia on 48-h Holter monitoring

Design

Data bank angiographic core laboratory study

Authors

BSBarry L. SharafInterventional / Structural Cardiology DWDavid O. WilliamsIntermountain Healthcare NMNicholas J. MieleBrown University

Discussion

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Implication

Reveals high-risk coronary anatomy in asymptomatic ischemia; leaves open whether angiography-guided management improves outcomes.

Key Points

This study aims to characterize the angiographic features of coronary pathology in patients with asymptomatic ambulatory electrocardiographic ischemia.
Reviewed coronary angiograms from patients with AECG ischemia enrolled in the ACIP study.
Assessed severity of coronary artery disease using percent stenosis and Thrombolysis in Myocardial Infarction flow grades.
Evaluated lesions for intracoronary thrombus, ulceration, and lumen contour.
75% of 439 patients with AECG ischemia had multivessel coronary artery disease.
62.2% had proximal stenoses ≥ 50% and 38.7% had stenoses ≥ 70%.
50.1% exhibited features suggesting complex plaque.

Study Design

Type

Cross-Sectional (n=466)

Multicenter

Yes

Structured PICO

Population

466 patients screened for the ACIP study (439 with asymptomatic AECG ischemia and 27 without) evaluated for angiographic severity and complexity of coronary artery disease.

Comparator

27 patients screened for the ACIP study who were ineligible because they did not have AECG ischemia on 48-h Holter monitoring.

Outcome

Angiographic features of coronary pathology, including quantitative measurement of percent stenosis, Thrombolysis in Myocardial Infarction flow grades, intracoronary thrombus, ulceration, and lumen contour.surrogate

Patients with asymptomatic ambulatory electrocardiographic ischemia frequently exhibit severe, complex, and multivessel coronary artery disease, which may explain their increased risk for adverse outcomes.

Cite This Study

Sharaf et al. (1997) conducted a cross-sectional in Asymptomatic cardiac ischemia (n=466). Asymptomatic AECG ischemia vs. No AECG ischemia was evaluated on Multivessel coronary artery disease. Asymptomatic AECG ischemia was frequently associated with multivessel coronary artery disease (75%), proximal stenoses ≥50% (62.2%), and complex plaque features (50.1%).

synapsesocial.com/papers/6a306c483b75c0bc11eadb3e https://doi.org/10.1016/s0735-1097(96)00444-5

Topics

Women and heart disease

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Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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