Role of Coronary Artery Revascularization in Heart Failure

Coronary artery disease is still the most common cardiac pathology leading to heart failure in the industrialized world. Studies in the 1970s established the benefit of surgical revascularization in patients with angina and extensive coronary artery disease, but excluded patients with left ventricular dysfunction. However, recent observational studies are demonstrating that there may be a benefit for surgical revascularization in patients with ischemic cardiomyopathy. To better understand the role of surgical revascularization in these patients, the Surgical Treatment for Ischemic Heart Failure (STICH) trial was designed. The focus of this article is to examine the outcome of this trial, and subsequent STICH Extension Study to provide the reader with the most current information regarding the role of coronary artery bypass grafting in patients with severe left ventricular dysfunction (ejection fraction < 35%).