Coronary Revascularisation in Severe Ischaemic Cardiomyopathy - To Stent or Not to Stent

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Coronary Revascularisation in Severe Ischaemic Cardiomyopathy – To Stent or Not to Stent

27/02/2023

Written by: Avraj Virdi

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Take home messages

Heart failure with reduced ejection fraction carries significant mortality and morbidity despite optimal medical and device therapy.
Coronary artery disease is the most common cause of left ventricular dysfunction in Europe.
To date, there is no evidence to suggest that revascularisation with percutaneous coronary intervention improves mortality, reduces heart failure hospitalisation or improves LV function in patients with severe left ventricular dysfunction and coronary artery disease.
Even in patients with viable myocardium on stress testing, randomised controlled trials have not yet shown any prognostic benefit in percutaneous coronary intervention.

Introduction

Heart failure with reduced ejection fraction (HFrEF) still has significant morbidity and mortality despite the advancements in medical and device therapy (1). In the West, the most common cause of left ventricular dysfunction is coronary artery disease (CAD) (1). The management of patients with severe left ventricular systolic dysfunction (LVSD) and significant CAD without a clear indication for revascularisation, such as acute coronary syndrome (ACS) or angina, has divided cardiology opinion.