CORONARY-ARTERY BYPASS SURGERY IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY

Abstract

Background: Ischemic cardiomyopathy (ICM), resulting from chronic coronary artery disease and left ventricular dysfunction, remains a major contributor to global cardiovascular morbidity and mortality. Coronary artery bypass grafting (CABG) has long been investigated as a therapeutic strategy in this high-risk group.

Objective: To review and synthesize evidence from epidemiological data, randomized controlled trials (RCTs), meta-analyses, observational studies, and guidelines regarding the role of CABG in patients with ICM.

Findings: Epidemiological reports (Mozaffarian et al., 2016) emphasize the global burden of cardiovascular disease and the ongoing need for effective revascularization strategies. The Coronary Artery Surgery Study (CASS, 1983) and its subgroup analysis (Passamani et al., 1985) provided the first RCT evidence supporting CABG survival benefits, particularly in patients with low ejection fraction (EF). The STICH trial (Velazquez et al., 2011) further established CABG’s mortality reduction compared with medical therapy in ischemic LV dysfunction. A meta-analysis by Yusuf et al. (1994) confirmed long-term survival advantages of CABG in multivessel disease. Observational evidence (Topkara et al., 2005) demonstrated the feasibility and improved outcomes of CABG in low EF patients with advances in surgical techniques. Clinical guidelines (Fihn et al., 2012; Yancy et al., 2013) integrated these findings into multidisciplinary management algorithms for stable ischemic heart disease and heart failure.

Conclusion: The cumulative evidence consistently supports CABG as a cornerstone therapy in ischemic cardiomyopathy, particularly in patients with multivessel CAD and reduced EF. With ongoing surgical innovations and guideline-directed application, CABG continues to play a vital role in improving survival and quality of life in this challenging population