Coronary revascularization in heart failure—old lessons relearnt: patient outcomes are paramount in the stenting era

Almost 50 years since its inception, coronary surgery (CABG) is still challenged in its quest to validate its appropriate place in the treatment of advanced coronary artery disease (CAD). Three excellent randomized controlled studies (RCTs) in the late 1970s and early 1980s—The Veteran’s Administration Co-operative Study (VA co-op S), the Coronary Artery Surgery Study (CASS) and the European Coronary Surgery Study (ECSS)—emphatically demonstrated superiority of CABG over medical management, in patients with multivessel disease. The prognostic benefits were even more dramatic when there was additional left ventricular dysfunction and were achieved even when perioperative mortality was 3.5–6%, and myocardial preservation techniques were unsophisticated [1–3]. The notion of patients with left ventricular dysfunction having an enhanced long-term prognosis initially seemed counter