Objective: To evaluate the prognostic role of myocardial revascularization and myocardial viability assessment in patients with ischemic cardiomyopathy (ICM).

Methods and Results: A review of randomized controlled trials assessing revascularization strategies in ICM identified two major studies: the STICH Trial and REVIVED-BCIS2 Trial, involving 1,912 patients. Participants received either revascularization plus optimal medical therapy (OMT) or OMT alone. Long-term follow-up from the STICHES study showed that coronary artery bypass grafting (CABG) with OMT reduced all-cause mortality by 16% compared with OMT alone over 9.8 years. However, myocardial viability and ischemia severity did not significantly affect outcomes. In contrast, the REVIVED-BCIS2 trial found no significant benefit of percutaneous coronary intervention (PCI) plus OMT over OMT alone for all-cause mortality or heart failure hospitalization. Myocardial viability assessment was also not associated with improved long-term outcomes.

Conclusion: Current evidence suggests that CABG may improve long-term prognosis in patients with ICM, whereas PCI does not provide significant prognostic benefit. Routine assessment of myocardial viability or ischemia is not supported as a key determinant for selecting revascularization strategies in ICM.

ischemic cardiomyopathy, CABG, PCI, myocardial viability, STICH, REVIVED-BCIS2

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