BACKGROUNDWhether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical therapy (i.e., individually adjusted pharmacologic and device therapy for heart failure) alone, is unknown. METHODSWe randomly assigned patients with a left ventricular ejection fraction of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability to a strategy of either PCI plus optimal medical therapy (PCI group) or optimal medical therapy alone (optimal-medical-therapy group). The primary composite outcome was death from any cause or hospitalization for heart failure. Major secondary outcomes were left ventricular ejection fraction at 6 and 12 months and quality-of-life scores. RESULTSA total of 700 patients underwent randomization -347 were assigned to the PCI group and 353 to the optimal-medical-therapy group. Over a median of 41 months, a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and in 134 patients (38.0%) in the optimal-medical-therapy group (hazard ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; P = 0.96). The left ventricular ejection fraction was similar in the two groups at 6 months (mean difference, −1.6 percentage points; 95% CI, −3.7 to 0.5) and at 12 months (mean difference, 0.9 percentage points; 95% CI, −1.7 to 3.4). Quality-of-life scores at 6 and 12 months appeared to favor the PCI group, but the difference had diminished at 24 months. CONCLUSIONSAmong patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure.

This research project has four strands: quantifying reporting of inquests; quantifying publicly available information from coroners' offices; investigating reasons for lack of coverage; and establishing solutions for making accounts and verdicts of inquests more accessible in a changed media landscape.Results show an overall reporting rate of only 11 per cent. Coverage varies wildly, with some "news deserts" where inquests are rarely reported. Deaths of younger people are more likely to be reported, as are male deaths. Information provided by coroners' offices also varies wildly despite national guidelines updated three years' ago recommending greater transparency. This report investigates the reasons for a lack of public scrutiny of coroners' courts by local media. Deaths may go unreported due to: the collapse of local newspapers and reduced staff in surviving organisations; the centralisation of police and newspaper offices, leading to fewer direct contacts between police and journalists; and a general cultural shift of passing media inquiries to a "communications team" which means news is filtered to give a more positive sense of police success.Recommendations: better implementation of existing guidelines: routine release of information regarding all deaths at which emergency services attend; and closer relationships with coroners' officers at inquest opening stage.