Revascularization for ischaemic cardiomyopathy.

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.