Revascularization in Ischemic Left Ventricular Dysfunction

Ischemic left ventricular dysfunction (iLVD) is the most prevalent cause of heart failure with reduced ejection fraction and is associated with higher mortality than nonischemic cardiomyopathy. Coronary revascularization was once considered routine for patients with iLVD, yet recent randomized trials have questioned this approach. This state-of-the-art review examines the pathophysiology of iLVD, explores the randomized evidence around coronary revascularization, and outlines which patients with iLVD should still be offered coronary artery bypass grafting or percutaneous coronary intervention (PCI). Finally, a step-by-step guide for planning and performing PCI in this population is provided. Attention is given to shared decision-making, nontechnical factors, and considerations for achieving complete revascularization, with a specific focus on upcoming trials of mechanical circulatory support.