Surgical Revascularization for Ischemic Cardiomyopathy in the Post-STICH Era

Coronary artery disease (CAD) accounts for significant morbidity and mortality in the United States and most developed countries. Patients with heart failure secondary to CAD have demonstrable poorer outcomes compared with those patients with heart failure because of other causes. Even when the causative relationship between CAD and systolic dysfunction can be unequivocally established, the controversy of revascularization in patients with ischemic cardiomyopathy continues to challenge clinicians. The potential benefit of revascularization has to be weighed against the higher operative and postoperative mortality of coronary artery bypass graft surgery in patients with very low ejection fraction and the possible futility of a high-risk intervention in certain patients. This review focuses on the role of surgical revascularization in patients with ischemic cardiomyopathy in light of data emerging from the original Surgical Treatment for Ischemic Heart Failure trial and its substudies, with an emphasis on the clinical implications for patient selection.