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Author Spotlight: Enhancing Coronary Artery Revascularization
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Author Spotlight: Enhancing Coronary Artery Revascularization

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Can Percutaneous Coronary Intervention Revive a Failing Heart?

Saad M Ezad1, Matthew Ryan1, Divaka Perera1

  • 1British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK.

Heart International
|February 6, 2023
PubMed

Insights

Percutaneous coronary intervention did not significantly improve outcomes for patients with coronary artery disease and heart failure. Optimal medical therapy remains the primary management strategy for this patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Research

Background:

  • Coronary artery disease (CAD) is the leading cause of heart failure with reduced ejection fraction.
  • Management strategies for CAD patients with ischaemic left ventricular systolic dysfunction require further evidence, particularly regarding revascularization.
  • Percutaneous coronary intervention (PCI) and surgical revascularization are potential treatment options.

Purpose of the Study:

  • To evaluate the efficacy of percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) versus OMT alone in patients with CAD and ischaemic left ventricular systolic dysfunction.
  • To compare the findings of the REVIVED-BCIS2 trial with those of the STICH trial (Surgical Treatment for Ischaemic Heart Failure).
  • To propose a clinical management pathway for patients with ischaemic left ventricular dysfunction.

Main Methods:

  • The REVIVED-BCIS2 trial was a randomized controlled trial assessing PCI in addition to OMT.
  • Patients included had stable CAD and ischaemic left ventricular systolic dysfunction.
  • Comparison was made with historical data from the STICH trial investigating surgical revascularization.

Main Results:

  • Percutaneous coronary intervention in addition to optimal medical therapy did not result in a statistically significant improvement in the primary composite endpoint compared to optimal medical therapy alone.
  • The study provides crucial data on the role of PCI in this specific patient population.
  • Comparison with the STICH trial offers insights into different revascularization strategies.

Conclusions:

  • Percutaneous coronary intervention does not appear to offer significant benefits over optimal medical therapy for patients with coronary artery disease and reduced ejection fraction.
  • Further research is needed to refine treatment strategies for ischaemic left ventricular systolic dysfunction.
  • Clinical decision-making should be guided by current evidence, considering both PCI and surgical revascularization options.

Keywords:
Heart failureischaemic cardiomyopathyleft ventricular systolic dysfunctionpercutaneous coronary interventionpercutaneous coronary revascularizationrandomized clinical trialviability

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