Debate. Percutaneous revascularization in dilated cardiomyopathy. Apropos of the REVIVED BCIS2 trial: the clinician’s view

Abstract

QUESTION: What’s your interpretation of the REVIVED BCIS2 trial? Which, would you say, are its most positive and debatable features? ANSWER: The REVIVED BCIS21 trial randomized stable patients with ischemic dilated cardiomyopathy to undergo percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) or OMT alone without revascularization. The trial included patients with left ventricular ejection fraction ≤ 35%, extensive coronary artery disease, and viability in 4 or more segments amenable to PCI. The results proved that the 2 strategies offered comparable outcomes regarding the primary composite endpoint of all-cause mortality or hospitalization-related heart failure (37.2% vs 38.0%; hazard ratio, 0.99; 95% confidence interval, 0.78-1.27; P = .96). There were no differences in the changes in left ventricular ejection fraction recorded at 6 months and at 1 year, with improvement confirmed in both groups.2 Previously, the STICH trial2,3 had demonstrated that surgical revascularization combined with OMT provided long-term overall survival benefits in patients with ischemic dilated cardiomyopathy, despite an initial increase in surgery-related mortality. Therefore, it was believed that the REVIVED BCIS2 trial, with the lower perioperative risk associated with PCI, could equal or even exceed these benefits. However, things have changed since the publication of the STICH trial, including...