Revascularization by PCI did not reduce the incidence of death from any cause or hospitalization for heart failure in patients with severe ischemic left ventricular systolic dysfunction, based on findings from the REVIVED study presented Aug. 27 during ESC Congress 2022 in Barcelona, and simultaneously published in the New England Journal of Medicine.

Divaka Perera, MD, et al., randomly assigned 700 patients with a left ventricular ejection fraction (LVEF) of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability to either PCI plus optimal medical therapy (n=347) or optimal medical therapy alone (n=353). The primary outcome was a composite of death from any cause or hospitalization for heart failure. Major secondary outcomes included LVEF at six and 12 months and quality-of-life scores.

Over a median of 41 months, researchers found a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and 134 patients (38%) in the optimal-medical-therapy group. The LVEF was similar in the two groups at both six and 12 months. Quality-of-life scores at six and 12 months appeared to favor the PCI group, but this difference decreased at 24 months.

"In our trial involving patients with severe left ventricular systolic dysfunction, extensive coronary disease, and dysfunctional but viable myocardium who received optimal medical therapy, the addition of revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure," said Perera, et al. They add that the REVIVED "observations mirror those in the STICH trial, in which revascularization by CABG did not affect left ventricular function, a finding that was consistent across the whole trial cohort, including the subgroup who underwent discretionary viability testing."

In a related editorial comment, Ajay J. Kirtane, MD, FACC, writes: "More than anything, this trial supports the importance of guideline-directed medical therapies for the management of left ventricular dysfunction, irrespective of whether revascularization is considered. … While the results of requisite additional analyses and follow-up data from the REVIVED trial are awaited, the prevailing dictum should be to diagnose the joint conditions of congestive heart failure and coronary artery disease and to provide therapies that are known to be effective for both of these conditions, as the goals of therapies that have not yet met that bar are carefully considered against their risks."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: ESC Congress, ESC22, ACC International, Ventricular Dysfunction, Myocardial Revascularization, Myocardial Ischemia

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