Revascularization for ischaemic cardiomyopathy.

PURPOSE OF REVIEW: Coronary artery disease is the most common cause of heart failure and is referred to as 'ischaemic cardiomyopathy'. There are no established guidelines for the role of revascularization in patients with heart failure in the absence of angina. This review evaluates the current state of knowledge on revascularization for the treatment of ischaemic cardiomyopathy.

RECENT FINDINGS: A large body of literature has supported the theoretical benefit of revascularization in recruiting hibernating or stunned myocardium. This has been supported by recent registry and population-based studies demonstrating a survival benefit after revascularization in patients with heart failure and coronary artery disease independent of angina. Some studies have suggested that coronary artery bypass grafting may be superior to percutaneous coronary intervention in a select group of patients. To date no randomized clinical trials have addressed the role of revascularization in this patient population. The STICH trial is the first randomized study specifically to assign patients predominantly with heart failure symptoms to surgery versus medical management, and is expected to be completed in 2008.

SUMMARY: Despite the lack of level 1 evidence, there is sufficient reasonable evidence lending credence to the concept that revascularization should be considered in patients with ischaemic cardiomyopathy.