Impact of Anatomical and Viability-Guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy
Authors: Saad M. Ezad, Margaret McEntegart, Matthew Dodd, Matthaios Didagelos, Novalia Sidik, Matthew Li Kam Wa, Holly P. Morgan, Antonis Pavlidis, Roshan Weerackody, Simon J. Walsh, James C. Spratt, Julian Strange, Peter Ludman, Amedeo Chiribiri, Tim Clayton, Mark C. Petrie, Peter O’Kane, Divaka Perera, Divaka Perera, Amedeo Chiribiri, Gerry Carr-White, Antonis Pavlidis, Simon Redwood, Brian Clapp, Aldo Rinaldi, Haseeb Rahman, Natalia Briceno, Sophie Arnold, Amy Raynsford, Mark Petrie, Margaret McEntegart, Stuart Watkins, Aadil Shaukat, Paul Rocchiccioli, Louise Cowan, Roshan Weerackody, Ceri Davies, Elliot Smith, Bhavik Modi, Peter O’Kane, Jehangir Din, Jonathon Hinton, John Greenwood, Jonathan Blaxill, Abdul Mozid, Michelle Anderson, Lana Dixon, Simon Walsh, Mark Spence, Patricia Glover, Richard Edwards, Adam McDiarmid, Mohaned Egred, Hannah Stevenson, George Amin-Youssef, Ajay Shah, Theresa McDonagh, Jonathan Byrne, Nilesh Pareek, Jonathan Breeze, Anthony Gershlick, Gerald McCann, Andrew Ladwiniec, Iain Squire, Donna Alexander, Kalpa De Silva, Julian Strange, Tom Johnson, Angus Nightingale, Laura Gallego, James Spratt, Claudia Cosgrove, Rupert Willia, Sam Firoozi, Pitt Lim, Dwayne Conway, Peter Swoboda, Paul Brooksby, James Cotton, Richard Horton, Stella Metherell, Kai Hogrefe, Adrian Cheng, Sian Sidgwick, Tim Lockie, Niket Patel, Roby Rakhit, Fozia Ahmed, Cara Hendry, Farzin Fath-Odoubadi, Douglas Fraser, Mamas Mamas, Miles Behan, Alan Japp, Nicholas Jenkins, Sam McClure, Karen Martin, Eltigani Abdelaal, Jaydeep Sarma, Sanjay Sastry, Jo Riley, Pradeep Magapu, Rod Stables, David Wright, Michael Mahmoudi, Andrew Flett, Nick Curzen, Sam Gough, Zoe Nicholas, Andrew Ludman, Hibba Kurdi, Sam Keenan, Kevin Thorpe, Prithwish Banerjee, Luke Tapp, Abeesh Panicker, Mark de Belder, Jeet Thambyrajah, Neil Swanson, Neville Kukreja, Mary Lynch, Girish Viswanathan, Elaine Jones, Sarah Norman, Helen Routledge, Jasper Trevelyan, Nick Pegge, Sukhbir Dhamrait, Tim Wells, Manas Sinha, Gavin Galasko, Christopher Cassidy, Tim Edwards, Javed Iqbal, Fraser Witherow, Kaeng Lee, James Beattie, Mike Pitt, Julian Gunn, Abdallah Al-Mohammad, Helen Denney, Huw Griffiths, Paul Kalra, Tim Gray, Jolanta Sobolewska, Steve Ramcharitar, Laura McCafferty, Thomas Martin, John Irving, Zaid Iskandar, Jason Glover, James Beynon, Maurice Pye, Simon Megarry, Paul Das, Chris Bellamy
Journal: Journal of the American College of Cardiology (2024)

Complete revascularization of coronary disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function. To identify the impact of complete revascularization in patients with severe LV dysfunction. Patients enrolled in the REVIVED-BCIS2 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 BCIS Jeopardy Score (BCIS-JS)] / [baseline BCIS-JS] and RImyo=[number of revascularized viable segments] / [ number of viable segments supplied by diseased vessels]. The 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. Of 700 randomized patients, 670 were included. The baseline BCIS-JS and SYNTAX scores were 8 (6 to 10) and 22 (15 to 29) respectively. In those assigned to PCI, median RIcoro and RImyo values were 67% and 85%. Compared to the group assigned to optimal medical therapy alone, there was no difference in the likelihood of the primary outcome in those 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. In patients with severe left ventricular dysfunction, neither complete anatomical nor viability-guided revascularization were associated with improved event-free survival compared to incomplete revascularization or treatment with medical therapy alone.