What Is the Evidence for Percutaneous Coronary Intervention or Coronary Artery Bypass Graft in Ischemic Cardiomyopathy?

Coronary artery disease has supplanted hypertension as the leading cause of congestive heart failure in the United States. The recognition that contraction abnormalities could accrue from gradual stunning, or longer-term 'hibernation,' raised the possibility that revascularization of viable but hypocontractile elements could improve myocardial performance. This review focuses on the data from randomized trials and registries regarding the potential benefits and risks of either coronary artery bypass grafting (CABG) or percutaneous coronary intervention for patients with severe left ventricular dysfunction secondary to coronary artery disease. For patients with medically refractory angina and ischemic cardiomyopathy, revascularization with CABG or percutaneous coronary intervention is recommended. The ongoing National Institutes of Health-sponsored Surgical Treatment for Ischemic Heart Failure (STICH) trial, a multicenter, prospective, randomized trial comparing contemporary medical therapy with CABG for patients with ischemic cardiomyopathy, should provide important information regarding patients who do not have angina. The conclusion of this review is that a trial of medical therapy vs. percutaneous coronary intervention could be of additional value, especially for patients at particularly high risk, when undergoing CABG.