Abstract 16558: Revascularization in Patients With Ischemic Cardiomyopathy and Viability: A Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Observational studies have suggested that revascularization improves survival in patients with ischemic cardiomyopathy (ICM) with left ventricular ejection fraction less than less than or equal to 35% and demonstrable myocardial viability compared to medical therapy alone. However, the recent Revascularization for Ischemic Ventricular Dysfunction (REVIVED) trial revealed that among patients with severe ischemic left ventricular systolic dysfunction receiving optimal medical therapy, percutaneous coronary intervention did not reduce the incidence of major adverse cardiac events. Hypothesis: This meta-analysis aims to evaluate the impact of revascularization on patients with ICM and demonstrable myocardial viability, specifically focusing on randomized controlled trials (RCTs). Methods: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews from inception to February 8th, 2023. The primary outcome assessed in this study was mortality. A random-effects models were applied to pool effect sizes. Results: Four RCTs involving 1365 patients with ICM and viability met the inclusion criteria. Among them, 684 patients were included in the revascularization group, while 681 patients received optimal medical therapy. In the revascularization group, 232 patients (34%) died, compared to 266 patients (39%) in the medical therapy group. The meta-analysis revealed that revascularization in this patient population was not associated with a significant improvement in survival (pooled odds ratio [OR]: 0.82; 95% CI: 0.59-1.14; p = 0.24). Furthermore, revascularization did not show a significant reduction in major adverse cardiac events (pooled odds ratio [OR]: 0.56; 95% CI: 0.27-1.16; p = 0.12). Conclusions: This meta-analysis of randomized controlled trials does not provide evidence supporting the effectiveness of revascularization in patients with ICM and demonstrable myocardial viability