Medical therapy and outcomes in REVIVED-BCIS2 and STICHES: an individual patient data analysis.

Ryan, Matthew; Petrie, Mark C; Kontopantelis, Evangelos; Dodd, Matthew; Tong, Guangyu; Marquis-Gravel, Guillaume; Docherty, Kieran F; Clayton, Tim; Lansky, Alexandra J; Mamas, Mamas A; Rouleau, Jean-Lucien; Velazquez, Eric J; Perera, Divaka

Abstract

In the Surgical Treatment for Ischaemic Heart Failure Trial Extension Study (STICHES), coronary artery bypass grafting (CABG) improved outcomes of patients with ischaemic left ventricular dysfunction receiving medical therapy, whereas in the Revascularization for Ischaemia Ventricular Dysfunction trial (REVIVED-BCIS2), percutaneous coronary intervention (PCI) did not. The aim of this study was to explore differences in outcomes of participants treated with medical therapy alone in STICHES vs. REVIVED-BCIS2 and to assess the incremental benefit of CABG or PCI. Pooled analysis of adjusted individual participant data from two multicentre randomized trials. All patients had left ventricular ejection fraction ≤35% and coronary artery disease and received medical therapy. Participants were randomized 1:1 to CABG (STICHES) or PCI (REVIVED-BCIS2). The primary outcome was the composite of all-cause death and hospitalization for heart failure over all available follow-up. A total of 1912 participants (88% male, 76% white ethnicity) were included with 98.3% completeness of follow-up for the primary outcome. The median follow-up was 118 months in STICHES and 41 months in REVIVED-BCIS2. Those receiving medical therapy alone in REVIVED-BCIS2 had fewer primary outcome events than those receiving medical therapy alone in STICHES (adjusted hazard ratio 0.60, 95% confidence interval 0.48-0.74, P < .001). Patients receiving PCI in REVIVED-BCIS2 were less likely to experience a primary outcome event than those receiving CABG in STICHES. Adjusted outcomes of patients treated with CABG in STICHES were worse than those receiving medical therapy alone in REVIVED-BCIS2. Patients with ischaemic cardiomyopathy receiving medical therapy in REVIVED-BCIS2 had better outcomes than those in STICHES, with or without CABG surgery. Further trials comparing CABG, PCI, and medical therapy in this population are warranted. [Abstract copyright: © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.]

Citation

Ryan, M., Petrie, M. C., Kontopantelis, E., Dodd, M., Tong, G., Marquis-Gravel, G., Docherty, K. F., Clayton, T., Lansky, A. J., Mamas, M. A., Rouleau, J.-L., Velazquez, E. J., & Perera, D. (in press). Medical therapy and outcomes in REVIVED-BCIS2 and STICHES: an individual patient data analysis. European Heart Journal, 1-11. https://doi.org/10.1093/eurheartj/ehaf080

• Journal Article Type: Article
• Acceptance Date: Jan 30, 2025
• Online Publication Date: Mar 6, 2025
• Deposit Date: Mar 27, 2025
• Journal: European heart journal
• Print ISSN: 0195-668X
• Electronic ISSN: 1522-9645
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: ehaf080
• Pages: 1-11
• DOI: https://doi.org/10.1093/eurheartj/ehaf080
• Keywords: Ischaemic heart disease, Heart failure, Revascularization, Coronary artery disease
• Public URL: https://keele-repository.worktribe.com/output/1110036