CABG Strategy in Low Ejection Fraction Patients

Patient Selection Criteria

CABG is reasonable and beneficial in patients with low ejection fraction (EF 35-50%) when significant multivessel disease or proximal LAD stenosis is present and viable myocardium exists in the region of intended revascularization, with even greater survival benefit when EF is below 50% 1
The American College of Cardiology recommends CABG in patients with EF <50% who have 3-vessel disease, as survival benefit is greater in this population compared to those with preserved EF 2, 3
For patients with severe LV systolic dysfunction (EF <35%), CABG might be considered with the primary intent of improving survival, whether or not viable myocardium is present 1
The presence of viable myocardium in the region of intended revascularization strengthens the Class IIa recommendation for patients with EF 35-50% 1

The American College of Cardiology recommends using the left internal mammary artery (LIMA) to bypass the left anterior descending artery in every patient, as this is associated with improved long-term outcomes even in low EF patients 2, 4

The American College of Cardiology states that the survival benefit of CABG exists regardless of symptom severity in multivessel disease with low EF 2, 3
Emergency CABG should not be performed within 3-7 days of acute MI unless ongoing ischemia with hemodynamic compromise exists, as surgical mortality is elevated during this window 4