Coronary Revascularization in Left Ventricular Dysfunction

Coronary revascularization in patients with left ventricular dysfunction seeks to restore myocardial perfusion to salvage hibernating or viable myocardium, attenuate adverse remodelling and improve survival and quality of life in ischaemic cardiomyopathy. Both percutaneous coronary intervention and coronary artery bypass grafting remain central to management when medical therapy alone is insufficient, yet patient selection and timing are critical. Evidence has shown that benefits are most pronounced in individuals with extensive coronary disease, demonstrable myocardial viability and optimised medical therapy. Nonetheless, large randomised trials have questioned the incremental advantage of revascularization over contemporary pharmacological regimens in certain high-risk cohorts, highlighting an ongoing debate regarding routine viability testing. Surgical grafting continues to offer durable revascularization in multivessel disease, whereas percutaneous approaches may be preferable in patients with prohibitive operative risk. Advances in imaging and physiological assessment have refined risk stratification, supporting personalised revascularization strategies. Global disparities in access to advanced revascularization and diagnostic modalities underscore the need for pragmatic algorithms that balance efficacy, procedural risk and resource availability.

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Research from all publishers

Recent prespecified analyses from a major randomised trial have investigated arrhythmic and survival outcomes in patients with severe left ventricular dysfunction undergoing percutaneous coronary intervention plus optimal medical therapy versus medical therapy alone. Findings indicate no significant reduction in all-cause mortality or potentially fatal ventricular arrhythmias over 24 months, challenging the assumption that revascularization independently mitigates electrical instability. A parallel subgroup analysis explored the prognostic value of myocardial viability assessment, demonstrating that the extent of non-viable myocardium—but not viable tissue—correlates with event-free survival and heart failure hospitalisation, while viability testing did not identify a cohort that derived clear survival benefit from intervention. A separate secondary evaluation focused on patient-reported health status and functional outcomes, revealing transient improvements in cardiomyopathy-specific quality of life at six months following percutaneous intervention, yet no sustained benefit at one or two years. Collectively, these studies underscore the complexity of selecting candidates for revascularization and the evolving role of viability imaging in guiding therapeutic decisions.

Coronary Revascularization in Left Ventricular Dysfunction publication trend

The graph below shows the total number of articles in coronary revascularization in left ventricular dysfunction across all publications each year (not limited to Nature Index journals).

Technical terms

Left ventricular ejection fraction: Proportion of blood ejected from the left ventricle during systole, expressed as a percentage.

Percutaneous coronary intervention: A catheter-based procedure to dilate coronary stenoses, often with stent implantation.

Coronary artery bypass grafting: Surgical revascularization using autologous vessels to bypass obstructed coronary arteries.

Myocardial viability: The capacity of dysfunctional myocardium to recover contractile function following restoration of blood flow.

Late gadolinium enhancement: Magnetic resonance imaging technique that identifies myocardial scar and fibrosis by delayed contrast uptake.

Optimal medical therapy: Comprehensive pharmacological regimen including antiplatelets, statins, β-blockers and renin–angiotensin inhibitors for ischaemic cardiomyopathy.

References

1. Arrhythmia and Death Following Percutaneous Revascularization in Ischemic Left Ventricular Dysfunction: Prespecified Analyses From the REVIVED-BCIS2 Trial. Circulation (2023).
2. Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction. JAMA Cardiology (2023).
3. Effect of PCI on Health Status in Ischemic Left Ventricular Dysfunction Insights From REVIVED-BCIS2. JACC Heart Failure (2024).