Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction

This randomized controlled trial (REVIVED-BCIS2) evaluated whether percutaneous coronary intervention (PCI) added to optimal medical therapy improves outcomes in patients with ischemic left ventricular systolic dysfunction. A total of 700 patients with ejection fraction ≤35%, multivessel coronary artery disease amenable to PCI, and myocardial viability were assigned to either PCI plus medical therapy or medical therapy alone. Over a median of 3.4 years, the primary outcome death or hospitalization for heart failure occurred in 37.2% (PCI) vs. 38.0% (medical therapy) of patients (HR: 0.99; 95% CI: 0.78–1.27; P=0.96), with no significant difference. Left ventricular ejection fraction and biomarkers (NT-proBNP) improved similarly across groups, and quality-of-life scores modestly favored PCI at 6 months but converged by 24 months. PCI reduced rates of unplanned revascularization (2.9% vs. 10.5%) but had higher early bleeding risk. The study concludes that routine PCI for ischemic LV dysfunction does not improve survival or reduce heart failure hospitalization beyond optimized medical care, challenging prior assumptions about revascularization in viable myocardium.

This randomized controlled trial (REVIVED-BCIS2) evaluated whether percutaneous coronary intervention (PCI) added to optimal medical therapy improves outcomes in patients with ischemic left ventricular systolic dysfunction. A total of 700 patients with ejection fraction ≤35%, multivessel coronary artery disease amenable to PCI, and myocardial viability were assigned to either PCI plus medical therapy or medical therapy alone. Over a median of 3.4 years, the primary outcome death or hospitalization for heart failure occurred in 37.2% (PCI) vs. 38.0% (medical therapy) of patients (HR: 0.99; 95% CI: 0.78–1.27; P=0.96), with no significant difference. Left ventricular ejection fraction and biomarkers (NT-proBNP) improved similarly across groups, and quality-of-life scores modestly favored PCI at 6 months but converged by 24 months. PCI reduced rates of unplanned revascularization (2.9% vs. 10.5%) but had higher early bleeding risk. The study concludes that routine PCI for ischemic LV dysfunction does not improve survival or reduce heart failure hospitalization beyond optimized medical care, challenging prior assumptions about revascularization in viable myocardium.