Revascularization for Ischemic Cardiomyopathy: Disproving the 45-Year-Old Concept of Hibernating Myocardium

The understanding of myocardial ischemia evolved from early twentieth-century studies showing reversible or irreversible damage depending on ischemia duration. The concept of hibernating myocardium emerged in the 1970s, describing chronically impaired but viable myocardium that could recover after revascularization. Initial observational studies supported revascularization benefits, but randomized trials such as PARR-2, HEART, and STICH showed mixed results, with STICH demonstrating mortality benefits only after extended follow-up. Advances in medical therapy and intervention raised questions about the role of revascularization, leading to recent trials such as ISCHEMIA and REVIVED-BCIS2, which showed limited benefit of revascularization over optimal medical therapy in stable patients.