From the Guidelines
There is generally no significant mortality benefit to getting a stent placed for patients with heart failure with reduced ejection fraction (HFrEF) unless they have specific indications for coronary revascularization, as stated in the 2024 ESC guidelines for the management of chronic coronary syndromes 1. Stent placement is primarily beneficial for patients with acute coronary syndrome or severe angina symptoms that persist despite optimal medical therapy. For HFrEF patients without these specific indications, the focus should be on optimizing guideline-directed medical therapy (GDMT) instead. GDMT for HFrEF typically includes:
- ACE inhibitors or ARBs (e.g., lisinopril 10-40 mg daily or valsartan 40-160 mg twice daily)
- Beta-blockers (e.g., carvedilol 3.125-25 mg twice daily or metoprolol succinate 12.5-200 mg daily)
- Mineralocorticoid receptor antagonists (e.g., spironolactone 12.5-50 mg daily)
- SGLT2 inhibitors (e.g., dapagliflozin 10 mg daily or empagliflozin 10 mg daily) These medications have been shown to reduce mortality and improve symptoms in HFrEF patients, as recommended by the 2024 ESC guidelines 1 and the 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure 1. The use of ACE inhibitors, ARBs, and SGLT2 inhibitors is strongly recommended for HFrEF patients to reduce the risk of HF hospitalization and death, as they have been shown to improve symptoms and survival in these patients 1. Stent placement in HFrEF patients without specific indications does not address the underlying pathophysiology of heart failure and may expose patients to unnecessary procedural risks without providing substantial benefits in terms of survival or quality of life.
From the Research
Mortality Benefit of Stent Placement in HFrEF
- There is no direct evidence in the provided studies to suggest a mortality benefit of stent placement in patients with Heart Failure with Reduced Ejection Fraction (HFrEF) 2, 3, 4, 5, 6.
- The studies primarily focus on medical therapy, device therapies, and management approaches for HFrEF, but do not mention stent placement as a treatment option for this condition.
- Device therapies such as implanted cardioverter defibrillators, cardiac resynchronization therapy, and trans catheter mitral valve repair are discussed as potential treatment options for specific subgroups of HFrEF patients 2, 4, 6.
- However, stent placement is not mentioned as a treatment option for HFrEF in any of the provided studies, suggesting that it may not be a recommended or commonly used treatment for this condition.