Coronary revascularization to improve left ventricular (LV) function and improve mortality in patients with ischemic cardiomyopathy remains controversial, especially in the absence of angina or ischemia. A large body of observational evidence suggests that patients with dysfunctional but viable myocardium may experience improvement in mortality and LV function after revascularization. However, results of randomized trials conducted in the last decade dispute the value of viability testing or coronary revascularization in improving outcomes of patients with ischemic cardiomyopathy. However, because of the numerous methodological limitations of these studies, clinical equipoise persists regarding the role of coronary revascularization in certain patients.
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