Effect of PCI on Health Status in Ischemic Left Ventricular Dysfunction
Authors: Matthew Ryan, Dylan Taylor, Matthew Dodd, John A. Spertus, Mikhail N. Kosiborod, Aadil Shaukat, Kieran F. Docherty, Tim Clayton, Divaka Perera, Mark C. Petrie, Divaka Perera, Amedeo Chiribiri, Gerry Carr-White, Antonis Pavlidis, Simon Redwood, Brian Clapp, Aldo Rinaldi, Haseeb Rahman, Natalia Briceno, Sophie Arnold, Amy Raynsford, Karen Wilson, Lucy Clack, Mark Petrie, Margaret McEntegart, Stuart Watkins, Aadil Shaukat, Paul Rocchiccioli, Marion McAdam, Elizabeth McPherson, Louise Cowan, Marie Wood, Roshan Weerackody, Ceri Davies, Elliot Smith, Bhavik Modi, Bindu Mathew, Oliver Mitchelmore, Rita Adrego, Mervyn Andiapen, Peter O’Kane, Jehangir Din, Sarah Kennard, Sarah Orr, Cathie Purnell, John Greenwood, Jonathan Blaxill, Abdul Mozid, Michelle Anderson, Kathryn Somers, Lana Dixon, Simon Walsh, Mark Spence, Patricia Glover, Caroline Brown, Richard Edwards, Adam McDiarmid, Mohaned Egred, Alla Narytnyk, Vera Wealleans, George Amin-Youssef, Ajay Shah, Theresa McDonagh, Jonathan Byrne, Nilesh Pareek, Jonathan Breeze, Catherine Antao, Kalpa De Silva, Julian Strange, Tom Johnson, Angus Nightingale, Laura Gallego, Cristina Medina, Anthony Gershlick, Gerald McCann, Andrew Ladwiniec, Iain Squire, Joanna Davison, Kris Kenmuir-Hogg, James Spratt, Claudia Cosgrove, Rupert Williams, Sam Firoozi, Pitt Lim, Giovanna Bonato, Vennessa Sookhoo, Dwayne Conway, Paul Brooksby, Judith Wright, Donna Exley, James Cotton, Richard Horton, Stella Metherell, Andrew Smallwood, Kai Hogrefe, Adrian Cheng, Charmaine Beirnes, Sian Sidgwick, Tim Lockie, Niket Patel, Roby Rakhit, Nina Davies, Angelique Smit, Fozia Ahmed, Cara Hendry, Farzin Fath-Odoubadi, Douglas Fraser, Mamas Mamas, Anu Oommen, Thabitha Charles, Miles Behan, Alan Japp, Belinda Rif, Nicholas Jenkins, Sam McClure, Pauline Oates, Karen Martin, Eltigani Abdelaal, Jaydeep Sarma, Sanjay Shastri, Jo Riley, Sarra Giannopoulou, Sophie Quinn, Pradeep Magapu, Rod Stables, David Wright, Janet Barton, Nichola Clarkson, Michael Mahmoudi, Andrew Flett, Nick Curzen, Judith Radmore, Sam Gough, Andrew Ludman, Hibba Kurdi, Samantha Keenan, Prithwish Banerjee, Luke Tapp, Nigel Edwards, Catherine Gibson, Neville Kukreja, Mary Lynch, Claire Barratt, Mark de Belder, Jeet Thambyrajah, Neil Swanson, Cath Richardson, Bev Atkinson, Girish Viswanathan, Darren Waugh, Helen Routledge, Jasper Trevelyan, Angela Doughty, Nick Pegge, Sukhbir Dhamrait, Sally Moore, Gavin Galasko, Christopher Cassidy, Natalia Waddington, Tim Edwards, Javed Iqbal, Fraser Witherow, Jenny Birch, Melanie Munro, Tim Wells, Manas Sinha, Linda Frost, Kaeng Lee, James Beattie, Mike Pitt, Alan Chung, Steve Ramcharitar, Laura McCafferty, Thomas Martin, John Irving, Zaid Iskandar, Anita Hutcheon, Julian Gunn, Abdallah Al-Mohammad, Michael Agyemang, Huw Griffiths, Paul Kalra, Serena Howe, Tim Gray, Jolanta Sobolewska, Louise Morby, Jason Glover, James Beynon, Janet Knight, Paul Das, Chris Bellamy, Emily Harman, Maurice Pye, Simon Megarry, Yvonne McGill, Heidi Redfearn
Journal: JACC Heart Failure (2024)

In the Revascularization for Ischemic Ventricular Dysfunction (REVIVED-BCIS2) trial, percutaneous coronary intervention (PCI) did not reduce the incidence of death or hospitalization for heart failure. This prespecified secondary analysis investigated the effect of PCI on health status measured with the KCCQ combined with the primary outcome in a win ratio. Participants with severe ischemic left ventricular dysfunction were randomized to either PCI in addition to optimal medical therapy (PCI) or optimal medical therapy alone (OMT). The primary outcome was a hierarchical composite of all-cause death, HHF and KCCQ overall summary score (OSS) at 24 months analysed using the unmatched win ratio. The key secondary endpoint was a KCCQ-OSS responder analysis. 347 participants were randomized to PCI and 353 to OMT. Median (IQR) age was 70.0 (63.3 to 76.1) years. Mean left ventricular ejection fraction was 27.0 ± 6.7 percent. PCI did not improve the primary endpoint (win ratio for PCI versus OMT, 1.05, 95% confidence interval, 0.88 to 1.26, p = 0.58). PCI resulted in more KCCQ-OSS responders than OMT at 6 months (55.7% vs. 41.0%, odds ratio (OR) 1.96 [95% CI 1.41 to 2.71], p < 0.001) and fewer deteriorators (23.9% vs. 31.2%, OR 0.69 [0.47 to 1.00], p = 0.048). PCI did not impact KCCQ-OSS responders or deteriorators at 12 or 24 months. PCI did not improve the hierarchical composite of death, hospitalization for heart failure and health status at 2 years. PCI improved KCCQ-OSS at 6 months but this benefit was not sustained to 1- or 2-year follow-up.