Key result
CABG fails to improve survival over medical therapy in CAD with LV dysfunction and viability.
Why the study?
The management of patients with coronary artery disease and heart failure has been debated for years, specifically regarding the pros and cons of revascularisation and viability assessment.
Does revascularization improve survival in patients with coronary artery disease and left ventricular dysfunction compared to medical therapy alone?
Does revascularization improve survival in patients with coronary artery disease and left ventricular dysfunction compared to medical therapy alone?
This review highlights the ongoing controversy regarding the benefit of revascularization and viability testing in patients with ischemic cardiomyopathy, noting that the STICH trial found no interaction between myocardial viability and treatment strategy regarding survival.
Viability testing should not guide CABG decisions in ischemic cardiomyopathy; leaves open optimal selection amid evolving medical therapy.
The management of patients with coronary artery disease and heart failure has been debated for years. In the 1980’s Braunwald coined the words “viability” and “stunning”. Multiple trials have been done since then. Since the early eighties coronary bypass grafting was considered as gold standard for patients with impaired left ventricular fraction and coronary artery disease. Since then, nuclear imaging studies have been used to evaluate the “viability” of the impaired areas and to decide if revascularisation would be reasonable. Beginning with the CASS study and ending with the more recent STICH study we aim to provide a “bird’s eye view” of the pros and cons for revascularisation. In addition, we aim to shed some light on the daily advancements in medical management, including devices and not just medication. We therefore chose the title “Back to the future” or maybe not.
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Grigorov et al. (2022) conducted a review in Coronary artery disease and left ventricular dysfunction. Coronary artery bypass grafting (CABG) vs. Medical therapy was evaluated. Coronary artery bypass grafting did not result in a significant survival benefit compared to medical therapy for patients with coronary artery disease, left ventricular dysfunction, and myocardial viability.
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