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Revascularization in Ischemic Heart Failure with Reduced Left Ventricular Ejection Fraction

Pawel Gasior1, Wojciech Wojakowski1, Elvin Kedhi2,3

  • 1Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Current Cardiology Reports
|April 3, 2023
PubMed

Insights

Myocardial revascularization in ischemic heart failure with reduced ejection fraction (HFrEF) aims to restore blood flow. Recent studies challenge the benefit of percutaneous coronary intervention (PCI) over optimal medical therapy, emphasizing tailored, multidisciplinary approaches.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) is a leading cause of heart failure (HF), particularly heart failure with reduced ejection fraction (HFrEF).
  • Ischemic etiology in HFrEF is associated with poorer patient outcomes compared to non-ischemic causes.
  • Myocardial revascularization aims to improve outcomes by restoring blood flow to underperfused myocardium, potentially reversing left ventricular hibernation and preventing myocardial infarction.

Purpose of the Study:

  • To review the indications, timing, and type of myocardial revascularization in patients with HFrEF and ischemic etiology.
  • To elaborate on the impact of complete revascularization in this patient population.
  • To discuss the evolving role of revascularization strategies in ischemic cardiomyopathy.

Main Methods:

  • Review of current literature and guidelines regarding myocardial revascularization for ischemic HFrEF.
  • Analysis of recent randomized trials comparing revascularization strategies (CABG, PCI) with optimal medical therapy.
  • Discussion of the multidisciplinary approach in decision-making for revascularization.

Main Results:

  • Coronary artery bypass graft surgery (CABG) has historically been the primary revascularization method for multivessel CAD in reduced ejection fraction (EF) patients.
  • Percutaneous coronary intervention (PCI) adoption has increased, but recent trials show no added benefit over optimal medical therapy in severe ischemic cardiomyopathy.
  • The decision for revascularization in ischemic cardiomyopathy requires a tailored strategy, considering the feasibility of complete revascularization.

Conclusions:

  • The role of revascularization in ischemic HFrEF is complex and debated, especially following recent trial outcomes.
  • A multidisciplinary team approach is essential for personalized treatment strategies in ischemic cardiomyopathy.
  • Achieving complete revascularization remains a consideration, but its feasibility and necessity must be individualized.
Abstract

Keywords:
Coronary artery bypass graftingCoronary artery diseaseHeart failurePercutaneous coronary intervention

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