The highly anticipated REVIVED trial found that percutaneous coronary intervention (PCI) does not reduce all-cause mortality or heart failure hospitalization in patients with severe ventricular dysfunction.
The researchers thought that PCI would improve outcomes in these patients, all of whom had myocardial viability, extensive and stable coronary artery disease, and severe ischaemic left ventricular dysfunction (ejection fraction ≤ 35%). In fact, the researchers selected this patient population because they were the most likely cohort to experience PCI benefits. The authors wanted to “stack the deck” in favor of intervention.
But when the investigators randomized 700 patients into either PCI or medical therapy groups, and then followed up between 2 and 8.5 years later, they found no clear PCI advantage.
- By a median of 3.4 years, 38% of the medical therapy group had either died or experienced heart failure hospitalization.
- Surprisingly, the percentage was exactly the same in the PCI group (hazard ratio: 0.99).
- There was also no difference in left ventricular ejection fraction at six and 12 months.
- By 2 years, quality-of-life scores were not significantly different.
The authors found no long-term benefit to the more invasive option for patients with stable coronary artery disease and impaired LV systolic function. That’s consistent with other studies showing PCI isn’t always safer or better than medication therapy for people with CAD, although it is the first to demonstrate these findings in this patient population. It might also prompt cardiologists to think twice before offering PCI to patients with ischemic cardiomyopathy.