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Updated: Aug 29, 2025
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Is the world ready for the STICH 3.0 trial?
Dominique Vervoort1,2, Marc E Jolicoeur3, Guillaume Marquis-Gravel3
1Institute of Health Policy, Management and Evaluation.
Insights
Coronary artery disease patients with impaired left ventricular function have worse outcomes. While coronary artery bypass grafting may be better than percutaneous coronary intervention, more research is needed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) is a leading cause of heart failure.
- Ischemic left ventricular systolic dysfunction (iLVSD) significantly worsens outcomes after revascularization.
- Current trials inadequately represent patients with iLVSD.
Purpose of the Study:
- To review coronary revascularization options for patients with iLVSD.
- To emphasize the need for randomized controlled trials (RCTs) in this population.
- To discuss the current evidence comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in iLVSD.
Main Methods:
- Review of existing literature and network meta-analyses of observational studies.
- Analysis of outcomes data comparing PCI and CABG in patients with iLVSD.
- Identification of knowledge gaps and future research directions.
Main Results:
- Observational studies suggest CABG may offer better survival rates than PCI in iLVSD patients.
- PCI has been associated with higher rates of mortality, cardiac death, and myocardial infarction.
- Advances in PCI technology are improving outcomes, but direct comparative evidence is lacking.
Conclusions:
- The optimal revascularization strategy for iLVSD remains uncertain.
- Observational data favors CABG, but RCT evidence is absent.
- New trials, like the Surgical Treatment for Ischemic Heart Failure 3.0, aim to resolve this clinical equipoise.
Purpose Of Review:
Coronary artery disease (CAD) is responsible for >50% of heart failures cases. Patients with ischemic left ventricular systolic dysfunction (iLVSD) are known to have poorer outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) compared to patients with a normal ejection fraction. Nevertheless, <1% of patients in coronary revascularization trials to date had iLVSD. The purpose of this review is to describe coronary revascularization modalities in patients with iLVSD and highlight the need for randomized controlled trial evidence comparing these treatments in this patient population.
Recent Findings:
Network meta-analytic findings of observational studies suggest that PCI is associated with higher rates of mortality, cardiac death, myocardial infarction, and repeat revascularization but not stroke compared to CABG in iLVSD. In recent years, outcomes for patients undergoing PCI have improved as a result of advances in technologies and techniques.
Summary:
The optimal coronary revascularization modality in patients with iLVSD remains unknown. In observational studies, CABG appears superior to PCI; however, direct randomized evidence is absent and developments in PCI techniques have improved post-PCI outcomes in recent years. The Surgical Treatment for Ischemic Heart Failure 3.0 consortium of trials will seek to address the clinical equipoise in coronary revascularization in patients with iLVSD.
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