Choice of revascularization strategy in patients with ischemic cardiomyopathy

CAD: coronary artery disease; CABG: coronary artery bypass grafting; NYHA: New York Heart Association; HF: heart failure; PCI: percutaneous coronary intervention; ICM: ischemic cardiomyopathy; LV: left ventricular; LVEF: left ventricular ejection fraction.

* In patients with worsening symptoms of HF or angina, decreased LV function, arrhythmias, or inducible ischemia on stress testing, obstructive CAD may be the cause. For more information on the symptoms and signs of obstructive CAD in patients with reduced LVEF, refer to UpToDate content on the management of ICM.

¶ Revascularization with CABG or PCI requires that the coronary anatomy is amenable to these approaches and that the benefit-to-risk profile is favorable for the patient. For further details on the risks and benefits of revascularization in this population, refer to UpToDate content on the treatment of ICM.

Δ Surgical risk should be determined by a multidisciplinary team that includes a cardiac surgeon and an HF cardiologist. The assessment of surgical risk includes cardiac and noncardiac risk factors. In general, a 30-day postoperative risk of mortality ≥10% identifies patients as high risk. For details on surgical risk assessment in this population, refer to UpToDate content on the treatment of ICM.

◊ Patients should be optimally managed before assigning a NYHA class. Refer to UpToDate content on the treatment of HF with reduced ejection fraction for information about optimal medical management and options for advanced HF treatment.

§ Left main CAD is defined as ≥50% stenosis of the left main coronary artery. Left main equivalent CAD is typically defined as ≥70% stenosis of the proximal left anterior descending coronary artery and of the proximal left circumflex artery.