Key result
Medical therapy in REVIVED-BCIS2 shows ~40% lower risk of major events than in STICHES.
Why the study?
CABG improved outcomes in STICHES while PCI did not in REVIVED-BCIS2, prompting an exploration of outcome differences with medical therapy alone across both trials and the incremental benefit of revascularization.
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?
Meta-Analysis (n=1,912)
1:1
Yes
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?
Effect estimate: adjusted HR 0.60 (95% CI 0.48-0.74)
p-value: p=< .001
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.
Contemporary medical therapy yields fewer events than historical regimens; extends STICHES data by quantifying temporal gains in ischaemic cardiomyopathy.
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.
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Ryan et al. (2025) conducted a meta-analysis in Ischaemic cardiomyopathy (n=1,912). Medical therapy in REVIVED-BCIS2 vs. Medical therapy in STICHES was evaluated on Composite of all-cause death and hospitalization for heart failure (adjusted HR 0.60, 95% CI 0.48-0.74, p=< .001). 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).
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