| Title: |
Impact of Anatomical and Viability-guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy. |
| Authors: |
Ezad, SM; McEntegart, M; Dodd, M; Didagelos, M; Sidik, N; Li Kam Wa, M; Morgan, HP; Pavlidis, A; Weerackody, R; Walsh, SJ; Spratt, JC; Strange, J; Ludman, P; Chiribiri, A; Clayton, T; Petrie, MC; O'Kane, P; Perera, D; REVIVED-BCIS2 investigators |
| Publisher Information: |
Elsevier |
| Publication Year: |
2024 |
| Collection: |
St George's University of London: Repository |
| Description: |
BACKGROUND: Complete revascularization of coronary disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function. OBJECTIVES: To identify the impact of complete revascularization in patients with severe LV dysfunction. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf; application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Language: |
English |
| ISSN: |
1558-3597 |
| Relation: |
https://openaccess.sgul.ac.uk/id/eprint/116536/6/1-s2.0-S0735109724071328-main.pdf; https://openaccess.sgul.ac.uk/id/eprint/116536/11/1-s2.0-S0735109724071328-mmc1.docx; https://openaccess.sgul.ac.uk/id/eprint/116536/1/1-s2.0-S0735109724071328-main.pdf; Ezad, SM; McEntegart, M; Dodd, M; Didagelos, M; Sidik, N; Li Kam Wa, M; Morgan, HP; Pavlidis, A; Weerackody, R; Walsh, SJ; et al. Ezad, SM; McEntegart, M; Dodd, M; Didagelos, M; Sidik, N; Li Kam Wa, M; Morgan, HP; Pavlidis, A; Weerackody, R; Walsh, SJ; Spratt, JC; Strange, J; Ludman, P; Chiribiri, A; Clayton, T; Petrie, MC; O'Kane, P; Perera, D; REVIVED-BCIS2 investigators (2024) Impact of Anatomical and Viability-guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy. J Am Coll Cardiol, 84 (4). pp. 340-350. ISSN 1558-3597 https://doi.org/10.1016/j.jacc.2024.04.043 SGUL Authors: Spratt, James |
| DOI: |
10.1016/j.jacc.2024.04.043 |
| Availability: |
https://openaccess.sgul.ac.uk/id/eprint/116536/; https://doi.org/10.1016/j.jacc.2024.04.043 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.3CCA42A2 |
| Database: |
BASE |