CABG biedt overlevingsvoordeel bij ischemisch HFrEF — narratieve review

Heart failure with reduced ejection fraction (HFrEF) of ischemic origin represents one of the leading causes of morbidity and mortality and is associated with a poor prognosis. Myocardial revascularization is a potentially effective therapeutic strategy to improve symptoms and outcomes; however, its benefit is not uniform and depends on multiple factors, including coronary anatomy, severity of left ventricular dysfunction, and the presence of myocardial scar. Available evidence indicates that coronary artery bypass grafting is the only revascularization strategy associated with a long-term prognostic benefit in selected patients, despite an increased early perioperative risk. In contrast, percutaneous coronary intervention appears to provide mainly symptomatic and quality-of-life benefits, without a significant impact on survival. At the same time, advances in optimal medical therapy have substantially modified the natural history of the disease, reducing the incremental benefit of revascularization. In this context, patient selection requires an integrated and multidisciplinary approach, with shared decision-making within the Heart Team to optimize the risk-benefit balance. The aim of this review is to critically appraise the role of myocardial revascularization in ischemic HFrEF considering the most recent evidence, with particular focus on patient selection and the integration of clinical and imaging data.