Revascularization in Ischemic Left Ventricular Dysfunction: a pathophysiology-guided, evidence-based approach.

Ischemic left ventricular dysfunction (iLVD) is the most prevalent cause of heart failure with reduced ejection fraction and is associated with higher mortality than non-ischemic cardiomyopathy. Coronary revascularization was once routinely considered for patients with iLVD, yet recent randomised trials have questioned this approach. This state-of-the-art review examines the pathophysiology of iLVD, examines 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, we provide a step-by-step guide for planning and performing PCI in this population. Attention is given to shared decision making, non-technical factors and considerations for complete revascularization, with a specific focus on upcoming trials of mechanical circulatory support.