Underestimating Medical Therapy for Coronary Disease . . . Again

The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, extensive coronary disease, and a left ventricular ejection fraction of more than 35%,13 the benefits of such a strategy are less clear when the ejection fraction is substantially impaired.The evidence base for the benefits of revascularization is even weaker when angina is not present in patients with ischemic cardiomyopathy. In such a situation, myocardial viability and hibernation (i.e., chronically hypoperfused myocardium resulting in a hypocontractile . . .