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.