[Türkçe] | |
Turkish Society of Cardiology Young Cardiologists Bulletin Year: 5 Number: 6 / 2022 |
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Reviewer: : Dr Elif Ayduk Gövdeli Name of the Study: Revascularisation for ischemic ventricular dysfunction: REVIVED trial Published Congress: ESC 2022 Background: Coronary artery disease is the most common cause of heart failure; associated with lower survival and quality of life. Revascularization to improve blood flow is a long-considered treatment option. Percutaneous coronary intervention (PCI) is an attractive alternative to bypass surgery without early adverse outcomes. However, there is no randomized evidence to support the efficacy and safety of PCI in these patients. Objective: The aim of this study is to investigate the efficacy and safety of PCI in patients with severe left ventricular dysfunction. Methods: Patients with severe left ventricular systolic dysfunction (ejection fraction 35% or less), extensive coronary artery disease, and patients with at least four viable dysfunctional myocardial segments that could be revascularized by PCI were enrolled. Patients with myocardial infarction in the last four weeks, decompensated heart failure, and sustained ventricular arrhythmias within the last 72 hours were excluded. A total of 700 patients at 40 centres in the UK were randomised 1:1 to the optimal medical treatment with PCI or the optimal medical treatment alone. The primary outcome is death from all causes or hospitalization for heart failure. The secondary outcome was determined as left ventricular ejection fraction and quality of life measures at 6 and 12 months. Results: The median age of the participants was 70 and 88% were male. The mean left ventricular ejection fraction was 28%. During a median follow-up of 3.4 years, the primary outcome was seen in 129 (37.2%) patients in the PCI group and 134 (38%) in the medical treatment group alone. The hazard ratio was determined as 0.99 (95% Confidence interval 0.78-1.27, p-value 0.96). There was no significant difference between the two groups in left ventricular ejection fraction measurements at 6 and 12 months. Although the 6th and 12th month quality of life data were in favour of the PCI group, no significant difference was observed between the two groups in the 24th month. Conclusion: PCI does not reduce all-cause mortality or hospitalization for heart failure in patients with severe left ventricular dysfunction and extensive coronary artery disease. Interpretations: PCI should not be recommended in stable patients with ischemic left ventricular systolic dysfunction, where our sole aim is prognostic benefit. However, it should be noted that this study excluded patients with restrictive angina or recent acute coronary syndrome for whom PCI is still an option. |
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