10-year outcomes post coronary artery bypass grafting in Asian patients with ischemic cardiomyopathy: a comprehensive analysis of survival and cardiac performance

Coronary artery disease (CAD) with impaired left ventricular ejection fraction (LVEF) is associated with high risks of mortality and morbidity. Patients are at risk of sudden death, ventricular arrhythmias and debilitating heart failure or anginal symptoms requiring repeated hospital admissions. Not only is this a major burden to healthcare institutions, choosing the appropriate management strategy for these patients is often challenging. CAD is the predominant etiology of left ventricular dysfunction (1), making up 60% of patients in the Acute Decompensated Heart Failure National Registry (2). Despite its significance, the role of CABG in ischemic cardiomyopathy (ICM) is understudied and guidance on the appropriate treatment for ICM is lacking. Historical studies have either excluded patients with poor LVEF or just included cardiomyopathy as part of subgroup analysis. Additional studies have showed a benefit in CABG in impaired LVEF with anginal symptoms but not so in patients with predominant heart failure symptoms. The STICH trial (3) is the only randomized controlled trial to date that has helped define the place of CABG in ICM, and CABG is now established as the first line therapy for patients with ICM and anatomy suitable for CABG