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. ISBN: 978-1-4731-3093-7 Comparison Medical management Outcomes CRITICAL All-cause mortality at 30 days (Time to event) All-cause mortality (Time to event) Quality of life at 12 months (Continuous) Unplanned hospitalisation at 12 months (Count rate) IMPORTANT Additional revascularisation events at 24 months (Count rate) Improvement of NYHA class at 12 months (Dichotomous) Improvement in ejection fraction at 12 months (Dichotomous) Adverse events - stroke at 12 months (Dichotomous) Study design Systematic Review RCT 6.3.1.3 Clinical evidence A search was conducted for randomised trials comparing the effectiveness of coronary revascularisation (CABG, CABG + ventricular reconstruction or PCI) with medical management in people with heart failure and reduced ejection fraction. Two studies (reported in 14 publications) were included in the review: HEART65 . These are summarised in Table 69 below. HEART compared an invasive strategy (angiography followed by PCI or CABG at the clinician s discretion) with medical management; STICH compared CABG and medical management. Evidence from these studies is summarised in the clinical evidence summaries below (Table 70 and Table 71). See also the study selection flow chart in Appendix C, forest plots in Appendix E, study evidence tables in Appendix F, GRADE tables in Appendix H and excluded studies list in Appendix I. Two studies were included within the 2003 CHF guideline.24, 75 and referred to narratively. These studies have been excluded within the current update as they no longer match the review protocol. For further explanation please see the excluded studies table (appendix I) and the Recommendations and link to evidence. Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 