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REVIVED BCIS-2: update and key learnings

Tesfamariam Aklilu Betemariam1, Holly Morgan1, Divaka Perera1,2

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

Current Opinion in Cardiology
|August 7, 2024
PubMed

Insights

Percutaneous coronary intervention (PCI) does not improve survival or left ventricular function in ischemic heart disease patients receiving optimal medical therapy. Viability testing also failed to identify patients who benefit from PCI, challenging current treatment paradigms.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Ischemic left ventricular dysfunction is a significant clinical challenge.
  • Treatment paradigms have historically included revascularization strategies.
  • The role of percutaneous coronary intervention (PCI) in this setting requires ongoing evaluation.

Purpose of the Study:

  • To summarize shifting paradigms in treating ischemic left ventricular dysfunction.
  • To analyze the results of the REVIVED-BCIS2 trial.
  • To assess the impact of PCI on survival, left ventricular function, arrhythmia, quality of life, and viability testing.

Main Methods:

  • Review of the REVIVED-BCIS2 trial and its sub-studies.
  • Analysis of outcomes related to PCI versus optimal medical therapy.
  • Evaluation of viability testing and scar burden as predictors of outcome.

Main Results:

  • PCI did not provide additional benefits over optimal medical therapy for survival, left ventricular function, arrhythmic risk, or quality of life.
  • Viability testing did not differentiate patients who would benefit from PCI.
  • Scar burden emerged as a significant predictor of outcome.

Conclusions:

  • The REVIVED trial outcomes challenge existing beliefs in managing ischemic left ventricular dysfunction.
  • There is a need to investigate evidence-free areas in clinical practice.
  • Future trials, like STICH3, aim to address remaining questions.
Abstract

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