Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction—European Society of Cardiology (ESC) Congress 2022 | SCAI

Why is this study important?

  • Patients with reduced left ventricular ejection fraction and coronary artery disease suffer from high rates of morbidity and mortality despite medical therapy.
  • PCI for the treatment of such patients is frequently performed, with the hopes of improving prognosis.
  • REVIVED-BCIS2 is the first large randomized controlled trial to study the effects of PCI in such patients.

What question was this study supposed to answer?

  • CABG has been shown to reduce 10-year (but not 5-year) mortality in patients with ischemic cardiomyopathy. However, CABG has a substantial early mortality risk, and this fact combined with its morbidity, makes CABG an unacceptable option in many patients.
  • Whether PCI, which has less procedural morbidity and mortality than CABG, has a benefit in these patients is an unanswered question.

What did the study show?

  • 700 patients with chronic coronary disease and severely reduced LV function, but mild or no symptoms were randomized to optimal medical therapy with and without PCI.
  • At a median follow-up of 41 months, there was no difference in death or heart failure hospitalization (the primary endpoint) or the 12-month LV function in patients treated with or without PCI.
  • PCI did reduce spontaneous myocardial infarctions, and improved symptoms during the 12 months of follow-up, although this difference diminished by 24 months.
  • The benefits of PCI in the long term, and in patients with ischemic cardiomyopathy with more than mild symptoms, have yet to be rigorously studied.
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