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Revascularization for ischaemic cardiomyopathy

Ganesh Shanmugam1, Jean-Francois Légaré

  • 1Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

Current Opinion in Cardiology
|February 28, 2008
PubMed

Insights

Revascularization may benefit patients with ischaemic cardiomyopathy and heart failure, even without angina. Current evidence suggests considering this treatment despite a lack of definitive guidelines.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Heart Failure Management

Background:

  • Coronary artery disease is a primary cause of heart failure, termed ischaemic cardiomyopathy.
  • Established guidelines for revascularization in heart failure without angina are lacking.
  • This review examines current knowledge on revascularization for ischaemic cardiomyopathy.

Purpose of the Study:

  • To evaluate the current state of knowledge on revascularization for ischaemic cardiomyopathy.
  • To assess the role of revascularization in heart failure patients with coronary artery disease but no angina.

Main Methods:

  • Literature review of existing studies and registries.
  • Analysis of evidence supporting revascularization for myocardial recovery.
  • Consideration of comparative effectiveness of different revascularization techniques.

Main Results:

  • Literature supports theoretical benefits of revascularization for hibernating or stunned myocardium.
  • Registry studies show survival benefits post-revascularization in heart failure patients with CAD, independent of angina.
  • Coronary artery bypass grafting may be superior to percutaneous coronary intervention in specific patient groups.

Conclusions:

  • Revascularization should be considered for patients with ischaemic cardiomyopathy.
  • Sufficient evidence supports the consideration of revascularization despite the absence of level 1 evidence.
  • The STICH trial is the first randomized study in this patient population.
Abstract

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