CORONARY ARTERY SURGERY: Edited by Marc RuelIs the world ready for the STICH 3.0 trial?Vervoort, Dominiquea,b; Jolicoeur, Marc E.c; Marquis-Gravel, Guillaumec; Fremes, Stephen E.a,b,d Author Information aInstitute of Health Policy, Management and Evaluation bDivision of Cardiac Surgery, University of Toronto, Toronto, Ontario cMontreal Heart Institute, University of Montreal, Montreal, Quebec dSchulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Correspondence to Stephen E. Fremes, MD, MSc, FRCSC, FACP, FACC, University of Toronto, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 05 Toronto, ON M4N 3M5, Canada. Tel: +1 416 480 6073; e-mail: [email protected] Current Opinion in Cardiology 37(6):p 474-480, November 2022. | DOI: 10.1097/HCO.0000000000001000 Buy Metrics Abstract Purpose of review Coronary artery disease (CAD) is responsible for >50% of heart failures cases. Patients with ischemic left ventricular systolic dysfunction (iLVSD) are known to have poorer outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) compared to patients with a normal ejection fraction. Nevertheless, <1% of patients in coronary revascularization trials to date had iLVSD. The purpose of this review is to describe coronary revascularization modalities in patients with iLVSD and highlight the need for randomized controlled trial evidence comparing these treatments in this patient population. Recent findings Network meta-analytic findings of observational studies suggest that PCI is associated with higher rates of mortality, cardiac death, myocardial infarction, and repeat revascularization but not stroke compared to CABG in iLVSD. In recent years, outcomes for patients undergoing PCI have improved as a result of advances in technologies and techniques. Summary The optimal coronary revascularization modality in patients with iLVSD remains unknown. In observational studies, CABG appears superior to PCI; however, direct randomized evidence is absent and developments in PCI techniques have improved post-PCI outcomes in recent years. The Surgical Treatment for Ischemic Heart Failure 3.0 consortium of trials will seek to address the clinical equipoise in coronary revascularization in patients with iLVSD. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.