Revascularization of coronary artery disease in heart failure. A European Journal of Heart Failure Expert Consensus Statement

The role of myocardial revascularization in HF patients with coronary artery disease by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) is controversial. For patients with HFrEF, prior to the advances in pharmacological heart failure therapy over the last 10 years, evidence suggests a modest, long-term benefit of CABG over guideline-recommended medical therapy. In the era of modern medical therapy, revascularization had no benefit in HFrEF. Whether a patient with HF and CAD should be advised to have revascularization and, if so, which procedure remains unclear and should be discussed by the heart team given the limited and conflicting evidence. Evidence for viability or ischaemia-guided selection strategies is controversial. In all cases with HF, establishing and optimizing GDMT and device therapy is required. When HF symptoms dominate despite GDMT, additional invasive procedures are not indicated. When angina persists despite GDMT and device therapy, revascularization should be considered. The choice of revascularization procedure should be discussed in the heart team, considering symptoms and ischemic burden, surgical risk, coronary complexity and the applicable HF treatment.