essence
background
Can revascularization by percutaneous coronary intervention (PCI) improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, while optimal medical therapy alone (ie, individually adjusted pharmacological and heart failure)? for device therapy), is unknown.
methods
We randomly assigned patients to have a left ventricular ejection fraction of 35% or less, extensive coronary artery disease for PCI, and PCI plus optimal medical therapy (PCI group) or a strategy of optimal medical therapy alone (optimal myocardial viability (optimal). – medical-medical group). The primary overall outcome was death from any cause or hospitalization for heart failure. The major secondary outcomes were ventricular ejection fraction and quality-of-life scores at 6 and 12 months.
Result
A total of 700 patients underwent randomization – 347 were assigned to the PCI group and 353 to the optimal-medication group. At a median of 41 months, a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and 134 patients (38.0%) in the optimal-of-therapy group (hazard ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; p = 0.96). Left ventricular ejection fraction was similar in the two groups at 6 months (mean difference, -1.6 percentage points; 95% CI, -3.7 to 0.5) and at 12 months (mean difference, 0.9 percentage points; 95% CI, -1.7 to 3.4) . Quality-of-life scores at 6 and 12 months appeared to favor the PCI group, but the difference had narrowed at 24 months.
conclusion
In patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI resulted in a low incidence of death from any cause or hospitalization for heart failure. (Funded by the National Institute for Health and Care Research Health Technology Assessment Program; revived-bcis2 clinicaltrials.gov no., nct01920048.)
(This story has not been edited by seemayo staff and is published from a rss feed)