The committee were uncertain about the cost effectiveness of CABG in a population that reflects those included in the STICH(ES) trial. The committee discussed that due to the higher uptake of ICDs nowadays, especially in younger patients, the survival benefit of CABG compared to those receiving medical therapy alone found in STICH(ES) could be negated and the average QALY gain could be low. However, the true effect of this is uncertain. The committee agreed that in exceptional cases CABG may be cost effective for a small proportion of people (the committee estimate less than 1%) with ischaemia and with characteristics similar to those in the STICH trial. The committee discussed that CABG should be decided on a case by case basis, resembling current clinical practice, and therefore agreed on a do not routinely offer recommendation. The cost of a PCI is much lower than CABG at 4,928. However, as there was no clinical evidence for PCI alone, the committee could not determine the cost-effectiveness of PCI. The committee were aware that the cost- effectiveness of PCI will be assessed in a health technology assessment alongside the REVIVE trial and therefore did not consider it important to make a research recommendation in this area. Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Other considerations The committee discussed current practice regarding coronary revascularisation for HFREF in the UK, and the potential impact of their recommendation. In the 2010 guideline, the recommendation was that coronary revascularisation should not be routinely considered. This was based on an evidence review conducted for the 2003 guideline, and the review was not updated in 2010. 