# CABG biedt overlevingsvoordeel bij ischemisch HFrEF — narratieve review

*geplaatst 2026-09-09 · Hartfalen · Giornale italiano di cardiologia (2006) · doi 10.1714/4755.47726 · https://hartvaat.nl/2026/09/01/cabg-biedt-overlevingsvoordeel-bij-ischemisch-hfref-narratieve-review/*

Deze narratieve review belicht de rol van myocardrevascularisatie bij patiënten met ischemisch hartfalen met een verminderde ejectiefractie (HFrEF). Hoewel CABG bij geselecteerde patiënten een langdurig overlevingsvoordeel biedt, levert PCI voornamelijk symptomatische verbetering zonder overlevingswinst. Gezien de vooruitgang in optimale medicamenteuze therapie is een zorgvuldige patiëntselectie via een Heart Team, gecombineerd met klinische en beeldvormende data, essentieel om het risico-batenprofiel te optimaliseren.

## English: [Myocardial revascularization in patients with heart failure with reduced ejection fraction and ischemic heart disease].

This narrative review examines myocardial revascularization in patients with ischemic heart failure with reduced ejection fraction (HFrEF). While coronary artery bypass grafting (CABG) demonstrates a long-term survival benefit in carefully selected patients, percutaneous coronary intervention (PCI) primarily offers symptomatic relief without a mortality advantage. With optimal medical therapy significantly altering disease progression, the authors emphasize that multidisciplinary Heart Team evaluation and integrated clinical and imaging data are crucial for optimizing patient selection and balancing procedural risks against clinical benefits.

## Abstract (original, from the publication)

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.

Auteurs: Maria Vittoria Matassini, Vittoria Rizzello, Simona Giubilato, Samuela Carigi, Paolo Desalvo, Francesco Piroli, Daniela Pini, Annalisa Turco, Maria Denitza Tinti, Christian Basile, Piero Gentile, Mariarosaria Catalano, Renata De Maria, Francesca Musella, Lucio Giuseppe Granata, Leonardo De Luca, Claudio Bilato, Fabrizio Oliva, Federico Nardi, Massimo Grimaldi

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Bron: Giornale italiano di cardiologia (2006), https://doi.org/10.1714/4755.47726. Bijgewerkt 2026-09-02T01:18:42Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.