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Role of Coronary Revascularization in Patients with Ischemic Heart Disease and Heart Failure with Reduced Ejection

Mikel Lacalle1, Pablo Bazal1,2, Jara García Ugalderbere2

  • 1Faculty of Health Sciences, Medicine, Public University of Navarre, 31009 Pamplona, Spain.

Journal of Clinical Medicine
|March 14, 2026
PubMed

Insights

Coronary revascularization benefits for heart failure with reduced ejection fraction (HFrEF) remain uncertain, especially with percutaneous coronary intervention (PCI). Further research is needed to clarify its role alongside optimal medical treatment (OMT).

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Heart failure with reduced ejection fraction (HFrEF) significantly impacts cardiovascular health, with ischemic heart disease as a primary cause.
  • Optimal medical treatment (OMT) has advanced, yet the added value of coronary revascularization in HFrEF patients is debated.
  • Previous studies show mixed results for revascularization, with coronary artery bypass grafting (CABG) suggesting potential benefits not consistently seen with percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To review and synthesize current evidence on the benefits of coronary revascularization in patients diagnosed with heart failure with reduced ejection fraction (HFrEF).
  • To address the uncertainties surrounding the efficacy of revascularization strategies in the context of evolving heart failure management.
  • To highlight the need for updated clinical trials due to recent advancements in OMT.

Main Methods:

  • Systematic review and synthesis of existing scientific literature.
  • Analysis of studies comparing coronary revascularization (CABG and PCI) versus OMT in HFrEF patients.
  • Evaluation of the role of myocardial hibernation in the context of revascularization.

Main Results:

  • Evidence for the benefit of coronary revascularization in HFrEF is inconsistent.
  • Coronary artery bypass grafting (CABG) shows some promise, but percutaneous coronary intervention (PCI) benefits are less clear.
  • The impact of myocardial hibernation requires further investigation.
  • Recent advancements in OMT complicate the interpretation of prior revascularization studies.

Conclusions:

  • The definitive role of coronary revascularization in HFrEF patients requires further clarification.
  • New clinical trials are essential to guide treatment decisions in light of contemporary OMT.
  • Personalized approaches considering revascularization techniques and patient-specific factors may be necessary.

Keywords:
coronary artery bypass graftingcoronary revascularizationheart failureischemic heart diseasepercutaneous coronary interventionreduced ejection fraction

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