Revascularization of coronary artery disease in heart failure. A European Journal of Heart Failure Expert Consensus Statement
Why the study?
The role of myocardial revascularization by PCI or CABG in heart failure patients with coronary artery disease remains controversial.
Does myocardial revascularization (PCI or CABG) improve outcomes in heart failure patients with coronary artery disease compared to guideline-directed medical therapy?
Comparison
Revascularization (PCI or CABG) vs guideline-directed medical therapy
Design
Expert consensus statement
Authors
Discussion
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Member takes
Implication
Requires heart team personalization of revascularization in HF-CAD; extends prior data by incorporating modern GDMT effects on outcomes.
Key Points
- This consensus statement examines the role of revascularization in patients with heart failure and coronary artery disease, emphasizing the need for tailored management strategies.
- Review of current literature on revascularization techniques, including PCI and CABG.
- Assessment of the efficacy of modern pharmacological therapy in heart failure and coronary artery disease.
- Discussion on patient selection criteria for revascularization procedures based on symptoms and ischemic burden.
- CABG showed modest long-term benefits over guideline-recommended medical therapy in HFrEF prior to modern pharmacological advancements.
- No significant benefit of revascularization reported in HFrEF patients under current medical therapies.
- Revascularization options should be personalized and involve discussions within the heart team considering various patient-specific factors.
Structured PICO
Does myocardial revascularization (PCI or CABG) improve outcomes in heart failure patients with coronary artery disease compared to guideline-directed medical therapy?
P
Population
Heart failure patients with coronary artery disease (CAD), including HFrEF
I
Intervention
Myocardial revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG)
C
Comparator
Guideline-directed medical therapy (GDMT)
This expert consensus statement recommends that revascularization in HF with CAD should be reserved for patients with persistent angina despite optimal GDMT, with decisions guided by a multidisciplinary heart team.
Limitations
- Limited and conflicting evidence
Cite This Study
Haring et al. (2026) conducted a review in Heart failure with coronary artery disease. Myocardial revascularization (PCI or CABG) vs. Guideline-directed medical therapy was evaluated. Myocardial revascularization in heart failure with coronary artery disease lacks proven benefit over modern medical therapy unless angina persists, requiring individualized heart team discussion.