Severe ischemic cardiomyopathy—a new answer in management?

An estimated 5.7 million adults in the United States have congestive heart failure (1,2). Furthermore, given our aging population and advancement in treatment, it is estimated that the prevalence of congestive heart failure will increase 0.7% by 2030 leading to a 215% increase in cost for treatment (1). Significant coronary artery disease (CAD) is still the most common cause of congestive heart failure in developed countries, commonly referred to as ischemic cardiomyopathy (3). The population-attributable risk in the United States has been estimated to be 68% in men and 56% in women (4). This patient population was found to have a shorter survival as compared to those with nonischemic cardiomyopathy (3). However, the role of revascularization of patients with CAD and left ventricular (LV) systolic dysfunction is not well established, particularly for patients with severe LV dysfunction [ejection fraction (EF) ≤35%].