Historically, however, there has only been anecdotal evidence of improvement in symptoms or left ventricular function following revascularisation in people with heart failure in the absence of the above special indications. Early randomised studies of coronary artery bypass grafting appeared to support revascularisation, whereby the patients who derived most benefit from surgical intervention were also those patients with impaired LV function, albeit in the context of selective randomisation. However, the landscape of cardiovascular management has changed through the prescription of newer drug therapies, routine acute angioplasty, changes in surgical interventions and the availability of device therapies such as implantable cardioverter defibrillators. It is therefore unclear if people with HFREF and severe CAD should be routinely offered myocardial revascularisation with CABG or PCI. Current practice varies widely depending on local interest and expertise as well as individual patient characteristics. This review was carried out to evaluate the emerging evidence in the field since the previous guidance was published regarding the clinical and cost effectiveness of coronary revascularisation in people with heart failure. 6.3.1.2 Review question: What is the clinical and cost effectiveness of coronary revascularisation with coronary artery bypass grafting or angioplasty in people with heart failure? For full details see review protocol in Appendix A. Table 68: PICO characteristics of review question Population People diagnosed with heart failure with reduced ejection fraction (HFREF). Intervention Coronary artery bypass graft surgery (CABG) CABG + ventricular reconstruction Percutaneous coronary intervention (PCI) Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 