March 6, 2025Open Access
View Full PaperMedical therapy and outcomes in REVIVED-BCIS2 and STICHES: an individual patient data analysis
Key Result
Patients receiving medical therapy alone in REVIVED-BCIS2 had fewer primary outcome events than those receiving medical therapy alone in STICHES (adjusted HR 0.60; 95% CI 0.48-0.74; P<0.001).
Study Design
Type
Meta-Analysis (n=1,912)
Randomization
1:1
Multicenter
Yes
Structured PICO
Do outcomes of patients with ischaemic cardiomyopathy receiving medical therapy alone or revascularization differ between the contemporary REVIVED-BCIS2 trial and the older STICHES trial?
P
Population
1,912 patients with ischaemic cardiomyopathy (left ventricular ejection fraction ≤35% and coronary artery disease), 88% male, 76% white ethnicity.
I
Intervention
Medical therapy alone or percutaneous coronary intervention (PCI) from the REVIVED-BCIS2 trial cohort
C
Comparator
Medical therapy alone or coronary artery bypass grafting (CABG) from the STICHES trial cohort
O
Outcome
Composite of all-cause death and hospitalization for heart failure over all available follow-upcomposite
Contemporary medical therapy for ischaemic cardiomyopathy (as seen in REVIVED-BCIS2) is associated with significantly better outcomes than older medical therapy (as seen in STICHES), and even outperformed historical outcomes with CABG.
Main Result
Effect estimate: adjusted HR 0.60 (95% CI 0.48-0.74)
p-value: p=< .001
Abstract
BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.