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Summary of New England Journal of Medicine, 387(15), 1426–1427. https://doi.org/10.1056/NEJMe2210183
New England Journal of Medicine, 387(15), 1351–1360. https://doi.org/10.1056/NEJMoa2206606
European Heart Journal, ehac568. https://doi.org/10.1093/eurheartj/ehac568
Dr. Rocco Vergallo et al

Points

• Multivessel PCI did not enhance event-free survival or Left Ventricular Ejection Fraction in individuals with severe ischemic cardiomyopathy, according to the REVIVED-BCIS2 study results.
• The STICH study discovered a link between coronary artery bypass graft surgery and better longevity among individuals with severe coronary artery disease and left ventricular systolic dysfunction.
• Less severe coronary artery disease, fewer victims, and a brief follow-up period might have contributed to PCI’s lack of effectiveness.

Summary

The trial’s objective was to compare the percutaneous coronary intervention to the best medical treatment for those with severe arterial disease and a left ventricular ejection fraction of around thirty-five percent.

The study design was declared a randomized controlled trial with parallel and open-label techniques. Participants with left ventricular ejection fraction below thirty-five percent and those with severe coronary artery disease were subjected to two groups. One was the PCI group having 347 participants, and the other was the one receiving standard medical intervention having 357 participants. 

The inclusion criterion was based on three groups: one was individuals with left ventricular ejection fraction below or equal to thirty-five percent. The second was participants with a severe arterial disorder, and the third was those with viability equal to or more than four in dysfunctional myocardial dysfunction. 

Those were excluded who had an acute myocardial infarction within four weeks—those with acute cardiovascular failure and consistent ventricular arrhythmia within seventy-two hours. All-cause death or hospitalization for cardiac arrest was the main endpoint, observed in thirty-seven percent of participants of the PCI group versus thirty-eight percent of the group receiving optimum medical treatment.   All subcategories exhibited the same results.

The secondary outcome observed in the PCI group was around a thirty-one percent death rate. Similarly, in the group receiving optimal medical care, the mortality outcomes were around thirty-two percent. Similarly, when secondary outcomes of acute myocardial infarction were observed, they came up around ten point seven percent in the PCI group and ten point eight percent in other groups receiving standard medical care. Consequently, when left ventricular ejection fraction at twelve months was observed in both groups, it reached zero point nine percent difference between them.

Multivessel PCI did not reduce all-cause mortality or enhance Left ventricular systolic function in patients with Left ventricular systolic dysfunction and severe coronary artery disease. However, there was no evidence that it was harmful. It’s still conceivable that individuals with the worst Atherosclerosis were recommended for coronary artery bypass surgery.

Links to the articles:
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac568/6754626
https://www.nejm.org/doi/full/10.1056/NEJMoa2206606
https://www.nejm.org/doi/full/10.1056/NEJMe2210183

References

Kirtane, A. J. (2022). Revive-ing a weak heart—Details matter. New England Journal of Medicine, 387(15), 1426–1427. https://doi.org/10.1056/NEJMe2210183
Perera, D., Clayton, T., O’Kane, P. D., Greenwood, J. P., Weerackody, R., Ryan, M., Morgan, H. P., Dodd, M., Evans, R., Canter, R., Arnold, S., Dixon, L. J., Edwards, R. J., De Silva, K., Spratt, J. C., Conway, D., Cotton, J., McEntegart, M., Chiribiri, A., … Petrie, M. C. (2022). Percutaneous revascularization for ischemic left ventricular dysfunction. New England Journal of Medicine, 387(15), 1351–1360. https://doi.org/10.1056/NEJMoa2206606
Vergallo, R., & Liuzzo, G. (2022). The REVIVED-BCIS2 trial: Percutaneous coronary intervention vs. optimal medical therapy for stable patients with severe ischaemic cardiomyopathy. European Heart Journal, ehac568. https://doi.org/10.1093/eurheartj/ehac568