Discusses the role of revascularization in the treatment of patients with severe heart failure. It concludes that CABG improves three-year survival rates in patients with moderate to severe left ventricular dysfunction and limiting angina. It is not clear, however, whether patients whose predominant symptom is heart failure rather than angina benefit from CABG, or how much ischemia is required to justify surgical intervention. In addition, the article contends that clinical outcomes after angioplasty have not been sufficiently studied to determine angioplasty's relative risks and benefits compared with those of CABG.
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