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Revascularisation for Ischaemic Cardiomyopathy

Matthew E Li Kam Wa1, Saba Z Assar2, Ajay J Kirtane2,3

  • 1Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK.

Interventional Cardiology (London, England)
|September 1, 2023
PubMed

Insights

Percutaneous coronary intervention may offer benefits similar to bypass surgery for heart failure patients with coronary artery disease, but without the surgical risks. The REVIVED-BCIS2 trial provides new insights into this approach.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Research

Background:

  • Coronary artery disease (CAD) is a primary cause of heart failure with reduced ejection fraction (HFrEF).
  • Coronary artery bypass grafting (CABG) improves quality of life and long-term outcomes but carries significant short-term risks in patients with severely impaired left ventricular (LV) function.
  • The optimal revascularization strategy for patients with ischemic cardiomyopathy remains a clinical challenge.

Purpose of the Study:

  • To evaluate the efficacy and safety of percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction.
  • To assess whether PCI can provide similar benefits to CABG without the associated surgical hazards.
  • To inform clinical decision-making regarding revascularization in patients with stable CAD and HFrEF.

Main Methods:

  • The REVIVED-BCIS2 trial (NCT01920048) was a randomized controlled trial.
  • It compared outcomes of PCI plus OMT versus OMT alone in patients with ischemic cardiomyopathy and viable LV myocardium.
  • Key endpoints included mortality, hospitalizations for heart failure, and quality of life measures.

Main Results:

  • The trial results are examined in detail within this review.
  • Preliminary findings suggest PCI may have a role in selected patients, but further analysis is ongoing.
  • The review discusses the implications of the trial for clinical practice and future research directions.

Conclusions:

  • The REVIVED-BCIS2 trial provides crucial data on the role of PCI in ischemic cardiomyopathy.
  • This review proposes a potential pathway for patient selection and revascularization decisions.
  • Unanswered questions regarding the long-term benefits and optimal patient profiles for PCI are explored.

Keywords:
Heart failureREVIVEDSTICHischaemic cardiomyopathypercutaneous coronary interventionreduced ejection fractionstable coronary artery disease

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