Medical therapy versus PCI for ischaemic cardiomyopathy

In patients with severe ischaemic left ventricular systolic dysfunction, percutaneous coronary intervention (PCI) did not reduce the composite incidence of all-cause death or hospitalisation for heart failure at a median follow-up of 3.4 years, compared with optimal medical treatment. Furthermore, PCI did not incrementally improve left ventricular ejection fraction (LVEF) or provide a sustained difference in quality-of-life, reported researchers from the first randomised REVIVED-BCIS2 trial in this patient population.

Patients with ischaemic cardiomyopathy continue to have high rates of mortality and hospitalisation for heart failure even with contemporary medical and device therapy. Previously, the STICHES trial has shown that revascularisation can improve the 10-year outcomes in this vulnerable patient population [1]. The REVIVED-BCIS2 trial (n=700; NCT01920048) sought to conclusively define the added value of PCI (n=353) over optimal medical therapy (n=353) in the first randomised trial in this population. The results were presented by Prof. Divaka Perera (Guy's & St Thomas' NHS Foundation Trust, London, UK) and were simultaneously published in the New England Journal of Medicine [2,3].

The primary composite endpoint of all-cause death or heart failure hospitalisation was not met: 37.2% of the PCI group experienced a primary endpoint event compared with 38% of the group on optimal medical treatment (HR 0.99; 95% CI 0.78–1.27; P=0.96), over a median of 3.4 years of follow-up. The treatment effect was consistent across all subgroups. There were also no significant differences in LVEF at 6 and 12 months.

Quality-of-life scores favoured PCI at the 6-month and 12-month timepoints, but the curves narrowed over time with medical therapy, and this advantage disappeared by 2 years, indicating that this benefit was not sustained (see Figure).

Figure: REVIVED major secondary endpoint was health-related quality-of-life (KCCQ score), which showed early differences, but the gap was not sustainable over time [2]



OMT, optimal medical therapy; PCI, percutaneous coronary intervention

1. Velazquez EJ, et al. N Engl J Med. 2016 Apr 21;374(16):1511-20.
2. Perera D, et al. REVIVED - Percutaneous Revascularisation for Ischaemic Ventricular Dysfunction. Hot Line Session 3, ESC Congress 2022, Barcelona, Spain, 26–29 August.
3. Perera D, et al. N Engl J Med. 2022 Aug 27. doi: 10.1056/NEJMoa2206606.

 

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Posted on 27 October 202227 October 2022