Role of Coronary Revascularization in Patients with Ischemic Heart Disease and Heart Failure with Reduced Ejection Fraction

TL;DR

This paper reviews whether coronary revascularization helps patients with heart failure and reduced heart function, especially those with ischemic heart disease.

Contribution

The paper provides a synthesis of current evidence on revascularization benefits in heart failure with reduced ejection fraction.

Findings

The benefit of CABG in HFrEF is suggested but not consistently observed with PCI.

Recent medical advances complicate the interpretation of older revascularization studies.

New clinical trials are needed to clarify revascularization's role in HFrEF.

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a major contributor to cardiovascular morbidity and mortality, with ischemic heart disease as the leading etiology. Despite advances in optimal medical treatment (OMT), the additional benefit of coronary revascularization in this population remains uncertain. While some studies describe a potential benefit in revascularization—particularly with coronary artery bypass grafting (CABG)—this benefit has not been consistently observed with percutaneous coronary intervention (PCI). Moreover, in this context, the role of myocardial hibernation has been called into question. Additionally, recent advances in the medical management of heart failure complicate the current interpretation of previous studies and underscore the need for new clinical trials. This review synthesizes the current evidence on the potential benefits of coronary revascularization in patients with heart failure with reduced ejection fraction (HFrEF).

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