Does early angiography pave the way for improved outcomes in patients with acute heart failure?

This editorial refers to ‘Early invasive coronary angiography and acute ischaemic heart failure outcomes’, by L.B. Kosyakovsky et al., doi:10.1093/eurheartj/ehab423. Coronary angiography has been a traditional diagnostic imaging test for epicardial coronary artery disease (CAD) and it provides ease of tailored decisions for cardiologists. There are some strengths and weaknesses of coronary angiography. It might potentially improve outcomes of heart failure (HF) patients by revascularization of epicardial CAD, as shown in the Surgical Treatment for Ischemic Heart Failure (STICH) trial,1 although it might potentially harm the patient by contrast nephropathy, radiation exposure, and bleeding complications. Hence, a relatively well-established indication for coronary angiography is that HF patients are amenable to surgical revascularization, since the publication of the STICH trial, in which coronary artery bypass grafting was superior to medical therapy alone by reducing all-cause mortality, cardiovascular (CV) mortality, and CV hospitalizations over up to 10 years of...