- Question
- To determine whether revascularization by percutaneous coronary intervention (PCI) improves event-free survival and left ventricular function in patients with severe ischemic systolic dysfunction, compared with optimal medical therapy alone.
- Design
- Randomized, open-label (unmasked) trial in which 700 patients were assigned to PCI plus optimal medical therapy or to optimal medical therapy alone, with a median follow-up of 41 months.
- Population
- Patients with a left ventricular ejection fraction of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability.
- Intervention
- PCI plus optimal medical therapy, defined as individually adjusted pharmacologic and device therapy for heart failure.
- Control
- Optimal medical therapy alone, without PCI revascularization.
- Primary outcome
- Composite of death from any cause or hospitalization for heart failure.
- Results
- The primary outcome occurred in 129 patients (37.2%) in the PCI group and 134 (38.0%) in the medical therapy group (HR 0.99; 95% CI 0.78 to 1.27; P = 0.96). Ejection fraction was similar between groups at 6 months (mean difference -1.6 percentage points; 95% CI -3.7 to 0.5) and at 12 months (0.9 percentage points; 95% CI -1.7 to 3.4).
- Conclusion
- In patients with severe ischemic systolic dysfunction receiving optimal medical therapy, PCI revascularization did not reduce the incidence of death from any cause or hospitalization for heart failure.
- Why it matters
- It challenged the notion that routine PCI revascularization in patients with ischemic cardiomyopathy and viable myocardium improves hard clinical outcomes, reinforcing the central role of optimal medical therapy. Quality-of-life scores appeared to favor PCI at early assessments, although the difference diminished over time.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026