TY - JOUR
T1 - Impact of Anatomical and Viability-Guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy
AU - REVIVED-BCIS2 Investigators
AU - Ezad, Saad M.
AU - McEntegart, Margaret
AU - Dodd, Matthew
AU - Didagelos, Matthaios
AU - Sidik, Novalia
AU - Li Kam Wa, Matthew
AU - Morgan, Holly P.
AU - Pavlidis, Antonis
AU - Weerackody, Roshan
AU - Walsh, Simon
AU - Spratt, James C.
AU - Strange, Julian
AU - Ludman, Peter
AU - Chiribiri, Amedeo
AU - Clayton, Tim
AU - Petrie, Mark C.
AU - O'Kane, Peter
AU - Perera, Divaka
AU - Carr-White, Gerry
AU - Redwood, Simon
AU - Clapp, Brian
AU - Rinaldi, Aldo
AU - Rahman, Haseeb
AU - Briceno, Natalia
AU - Arnold, Sophie
AU - Raynsford, Amy
AU - Petrie, Mark
AU - Watkins, Stuart
AU - Shaukat, Aadil
AU - Rocchiccioli, Paul
AU - Cowan, Louise
AU - Davies, Ceri
AU - Smith, Elliot
AU - Modi, Bhavik
AU - Din, Jehangir
AU - Hinton, Jonathon
AU - Greenwood, John
AU - Blaxill, Jonathan
AU - Mozid, Abdul
AU - Anderson, Michelle
AU - Edwards, Richard
AU - Shah, Ajay
AU - McDonagh, Theresa
AU - Byrne, Jonathan
AU - Pareek, Nilesh
AU - De Silva, Kalpa
AU - Lockie, Tim
AU - Wright, David
AU - Pitt, Mike
AU - Das, Paul
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/7/23
Y1 - 2024/7/23
N2 - Background: Complete revascularization of coronary artery disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function. Objectives: This study sought to identify the impact of complete revascularization in patients with severe LV dysfunction. Methods: Patients enrolled in the REVIVED-BCIS2 (Revascularization for Ischemic Ventricular Dysfunction) trial were eligible if baseline/procedural angiograms and viability studies were available for analysis by independent core laboratories. Anatomical and viability-guided completeness of revascularization were measured by the coronary and myocardial revascularization indices (RIcoro and RImyo), respectively, where RIcoro = (change in British Cardiovascular Intervention Society Jeopardy score [BCIS-JS]) / (baseline BCIS-JS) and RImyo= (number of revascularized viable segments) / (number of viable segments supplied by diseased vessels). The percutaneous coronary intervention (PCI) group was classified as having complete or incomplete revascularization by median RIcoro and RImyo. The primary outcome was death or hospitalization for heart failure. Results: Of 700 randomized patients, 670 were included. The baseline BCIS-JS and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 8 (Q1-Q3: 6-10) and 22 (Q1-Q3: 15-29), respectively. In those patients assigned to PCI, median RIcoro and RImyo values were 67% and 85%, respectively. Compared with the group assigned to optimal medical therapy alone, there was no difference in the likelihood of the primary outcome in those patients receiving complete anatomical or viability-guided revascularization (HR: 0.90; 95% CI: 0.62-1.32; and HR: 0.95; 95% CI: 0.66-1.35, respectively). A sensitivity analysis by residual SYNTAX score showed no association with outcome. Conclusions: In patients with severe LV dysfunction, neither complete anatomical nor viability-guided revascularization was associated with improved event-free survival compared with incomplete revascularization or treatment with medical therapy alone.
AB - Background: Complete revascularization of coronary artery disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function. Objectives: This study sought to identify the impact of complete revascularization in patients with severe LV dysfunction. Methods: Patients enrolled in the REVIVED-BCIS2 (Revascularization for Ischemic Ventricular Dysfunction) trial were eligible if baseline/procedural angiograms and viability studies were available for analysis by independent core laboratories. Anatomical and viability-guided completeness of revascularization were measured by the coronary and myocardial revascularization indices (RIcoro and RImyo), respectively, where RIcoro = (change in British Cardiovascular Intervention Society Jeopardy score [BCIS-JS]) / (baseline BCIS-JS) and RImyo= (number of revascularized viable segments) / (number of viable segments supplied by diseased vessels). The percutaneous coronary intervention (PCI) group was classified as having complete or incomplete revascularization by median RIcoro and RImyo. The primary outcome was death or hospitalization for heart failure. Results: Of 700 randomized patients, 670 were included. The baseline BCIS-JS and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 8 (Q1-Q3: 6-10) and 22 (Q1-Q3: 15-29), respectively. In those patients assigned to PCI, median RIcoro and RImyo values were 67% and 85%, respectively. Compared with the group assigned to optimal medical therapy alone, there was no difference in the likelihood of the primary outcome in those patients receiving complete anatomical or viability-guided revascularization (HR: 0.90; 95% CI: 0.62-1.32; and HR: 0.95; 95% CI: 0.66-1.35, respectively). A sensitivity analysis by residual SYNTAX score showed no association with outcome. Conclusions: In patients with severe LV dysfunction, neither complete anatomical nor viability-guided revascularization was associated with improved event-free survival compared with incomplete revascularization or treatment with medical therapy alone.
KW - complete revascularization
KW - heart failure
KW - left ventricular dysfunction
KW - percutaneous coronary intervention
KW - stable coronary artery disease
UR - http://www.scopus.com/inward/record.url?scp=85197624091&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2024.04.043
DO - 10.1016/j.jacc.2024.04.043
M3 - Article
C2 - 38759904
AN - SCOPUS:85197624091
SN - 0735-1097
VL - 84
SP - 340
EP - 350
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -