Key result
Baseline surgical risk fails to modify revascularization mortality benefits over OMT in ischemic LV dysfunction.
Why the study?
Randomized trials evaluating CABG and PCI against OMT in ischemic left ventricular systolic dysfunction may differ in baseline surgical risk, which may modify treatment effects.
Does baseline surgical risk modify the effect of PCI or CABG versus OMT on all-cause mortality in patients with ischemic left ventricular systolic dysfunction?
Cohort (n=1,866)
Open-label
Randomized in original trials
Yes
Does baseline surgical risk modify the effect of PCI or CABG versus OMT on all-cause mortality in patients with ischemic left ventricular systolic dysfunction?
Hazard Ratio: 1 (95% CI 0.76–1.31)
Absolute Event Rate: 31.4% vs 31.6%
p-value: p=.993
Baseline surgical risk does not appear to modify the relative treatment effects of PCI or CABG compared to medical therapy in patients with ischemic cardiomyopathy.
Baseline surgical risk does not modify PCI or CABG effects versus OMT; leaves open whether risk stratification should guide decisions in ischemic LVSD.
Abstract Background Coronary artery bypass grafting (CABG) improves survival compared with optimal medical therapy (OMT) alone in patients with ischemic left ventricular systolic dysfunction (iLVSD), but percutaneous coronary intervention (PCI) did not show clinical benefits in this population. However, the randomized controlled trials (RCT) evaluating these 2 revascularization modalities may differ in terms of baseline surgical risk. The aim is to investigate whether the treatment effects of PCI vs OMT, and of CABG vs OMT, are modified by baseline surgical risk. Methods A post hoc analysis of the Revascularization for Ischemic Ventricular Dysfunction – British Cardiovascular Intervention Society 2 (REVIVED-BCIS2) and Surgical Treatment for Ischemic Heart Failure (STICH) RCT comparing PCI and CABG vs OMT, respectively, in patients with iLVSD, was conducted. The main outcome was all-cause mortality. Interaction between randomized treatment and baseline surgical risk, estimated by a modified European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II, was quantified. Results A total of 666 participants from the REVIVED-BCIS2 trial and 1200 participants from the STICH trial were included. Participants from the REVIVED-BCIS2 trial were more likely to be in the highest tertile of baseline EuroSCORE-II (40.4% vs 29.4%, respectively; P < .001). In the REVIVED-BCIS2 trial, PCI had a consistent lack of effect on all-cause mortality vs OMT across baseline EuroSCORE-II tertiles (P for interaction=.79). In the STICH trial, CABG reduced mortality consistently vs OMT across baseline EuroSCORE-II tertiles (P for interaction=.64). Conclusions In the 2 largest RCT evaluating the impact of revascularization in iLVSD and multivessel coronary disease, the treatment effect of PCI vs OMT, and of CABG vs OMT, was not modified by baseline surgical risk.
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Marquis‐Gravel et al. (2025) conducted a cohort in Ischemic left ventricular systolic dysfunction (n=1,866). Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) vs. Optimal medical therapy (OMT) alone was evaluated on All-cause mortality (REVIVED-BCIS2 PCI vs OMT) (HR 1.00, 95% CI 0.76-1.31, p=.993). In patients with ischemic left ventricular systolic dysfunction, the treatment effects of PCI versus OMT and CABG versus OMT on all-cause mortality were not modified by baseline surgical risk (P for interaction=0.79 and 0.64, respectively).
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