Myocardial Revascularization in Heart Failure: A State-of-the-Art Review

J Card Fail. 2024 Oct;30(10):1330-1342. doi: 10.1016/j.cardfail.2024.08.002.

Abstract

Patients with heart failure (HF) and underlying coronary artery disease (CAD) have a substantially higher risk of mortality compared with those with HF from other causes. However, identifying individuals with HF for whom revascularization is likely to improve prognosis is a complex clinical decision. Revascularization is likely beneficial for patients with CAD-predominant symptoms, such as those with acute myocardial infarction or stable ischemic heart disease with refractory angina. However, for patients with HF-predominant symptoms, characterized by dyspnea without acute myocardial infarction or refractory angina, the benefits of revascularization are less clear. This state-of-the-art review summarizes the outcomes, clinical trials, and therapeutic approaches for patients with both CAD and HF, and proposes a therapeutic algorithm to guide the diagnosis and comprehensive workup of these complex patients.

Keywords: Myocardial revascularization; chronic heart failure; coronary artery disease; left ventricular systolic dysfunction.

Publication types

  • Review

MeSH terms

  • Coronary Artery Disease / surgery
  • Heart Failure* / surgery
  • Heart Failure* / therapy
  • Humans
  • Myocardial Revascularization* / methods
  • Treatment Outcome