Myocardial Revascularization in Heart Failure With Reduced Ejection Fraction

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Heart Failure Research

Background:

• Heart failure with reduced ejection fraction (HFrEF) patients increasingly face non-cardiovascular mortality.
• The long-term impact of myocardial revascularization (PCI or CABG) on HFrEF patients with ischemic cardiomyopathy is not well-defined.

Purpose of the Study:

• To review the current evidence on the long-term outcomes of myocardial revascularization in patients with HFrEF and ischemic cardiomyopathy.
• To evaluate the role of revascularization procedures in the context of modern pharmacotherapy for HFrEF.

Main Methods:

• A selective literature search was conducted for relevant clinical studies and current guidelines.
• Analysis of data from randomized controlled trials, including the STICH trial, and comparative studies on HF pharmacotherapy.

Main Results:

• Pharmacotherapy for HFrEF has substantially increased patient survival, adding an average of 8.3 years for a 55-year-old.
• Coronary artery bypass grafting (CABG) demonstrated a long-term survival benefit compared to medical treatment alone in HFrEF patients with severe coronary heart disease (STICH trial: HR 0.84 for all-cause death).
• No randomized controlled trials directly comparing CABG and percutaneous coronary intervention (PCI) are available.

Conclusions:

• Optimal guideline-directed medical therapy is crucial for long-term survival in HFrEF patients.
• The decision for myocardial revascularization should involve an interdisciplinary cardiac team, considering patient-specific factors and current medical therapy.