REVIVED-BCIS2 Trial

1. REVIVED-BCIS2 Trial
By Philippe Taieb, MD

2. Background: Hibernating Myocardium

3. STICH(ES) TRIAL
• EF≤35% + CAD randomized to CABG vs CABG+ OMT. LM
excluded.
• RCT 1:1
• Multicenter (99 sites over 22 countries )
• Funded by NIH.
• 1212 patients recruited between July 2002 to May
2007.
• Primary outcome: death from any cause
• Secondary outcome: death from CV causes, Composite
of all-cause death (ACD) + Hospitalization (CV, HF, all
cause), ACD + revasc, ACD + MI, ACD + stroke
• 10 year FU.

4. At 5 year FU, 1⁰ outcome
with HR of 0.86 but p=
0.12. All secondary
outcomes, already
statistically significant
with similar HRs.

5. REVIVED-BCIS2
• RCT 1:1
• Multicenter (40 centers in UK)
• Funded by UK Department of Health (NIHR).
• 700 patients recruited between August 2013
and March 2020.

8. BCIS-JS
• BCIS-JS ≥ 6 represents
LM, PROX LAD, PROX
LCX in Left dominant
system or Multivessel
disease.
• No mention of ischemia,
lesion severity, FFR/iFR.
• Not much evidence of
BCIS-JS validity aside
from strong specificity
for >12% ischemia on
CMR.

9. Viability
• CMR(70%): ≤25% transmural
LGE. For 26-50%, adjudication
at the discretion of the
recruiting centers.
• DSE (26%): improvement in
contraction by ≥ 1 grade
during low-dose Dobutamine.
• SPECT: tracer uptake >50%
than maximal uptake
segment at rest.
• PET : perfusion-metabolism
mismatch.
4%

10. 63% in STICH
36% in STICH
59% in STICH
60 y.o. in STICH
Same as STICH

11. Results of REVIVED Trial

12. Results

13. Results
Mean EF difference 0.9% (95%CI -
1.7 to 3.4)
No significant difference in
Symptoms, NYHA class or CCS class

14. Relatively low number of events rates.
Underpowered?

15. OMT: REVIVED VS STICH

16. ICD
STICH ->

17. Full Revascularization?

18. Viability: does it matter?

19. Food for thoughts
• Relatively low recruitment rate- no disclosure
of number screened. More severe disease not
enrolled in study?
• Healthier patients than average patient with
severe ICM =>50% with ≤2 vessel disease, 2/3
without angina and NYHA I/II => Tx dilution
effect.
• 10% crossover from OMT to PCI.
• Benefit will emerge after longer FU period?