Prognostic impact of inducible ischaemia in ischaemic left ventricular dysfunction: the REVIVED-BCIS2 trial

Retrospective observational data suggest that the presence and extent of inducible myocardial ischaemia predict future adverse cardiac events in patients with ischaemic heart disease. However, several randomized trials have failed to identify an association between the burden of inducible ischaemia and outcomes in patients with stable coronary artery disease (CAD) assigned to medical therapy alone or revascularization.1,2 Despite this, the presence and extent of ischaemia are commonly used to guide revascularization of stable patients. Notably, many of these analyses excluded patients with impaired left ventricular (LV) function. REVIVED-BCIS2 was a prospective, multi-centre, randomized controlled trial, investigating whether percutaneous coronary intervention (PCI) improved clinical outcomes in patients with severe ischaemic LV dysfunction (ILVD), compared with optimal medical therapy (OMT) alone.3,4 Whilst ischaemia testing was not mandated by protocol, it was performed as part of routine clinical practice in selected patients. Based on these data, we sought to determine whether the presence and extent of ischaemia detected on stress perfusion cardiac magnetic resonance (CMR) imaging predict clinical outcomes and response to PCI, in patients with ILVD.