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Brazilian Journal of Cardiovascular Surgery Acute heart failure (AHF) refers to rapid onset or worsening of signs and symptoms of heart failure, often requiring hospitalization and urgent treatment, due to its potentially life-threatening condition[1]. The vast-majority of patients that suffers from heart failure has acute worsening episodes that become more frequent as the disease progresses. More than half of these patients are known to have an ischemic etiology, and early revascularization improve clinical outcomes[2,3], and the immediate invasive strategy with intent to perform revascularization in patients with both AHF and acute coronary syndrome is recommended in guidelines[4,5]. However, the choices of revascularization are still controversial subject: either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Which one is better has been long debated. Trials comparing both techniques have shown that the rates of most adverse clinical outcomes favor CABG, which turns this technique as the preferred revascularization strategy in patients with multivessel disease. Unfortunately, most of the trials comparing PCI versus CABG were designed in the setting of stable coronary artery disease. The majority of patients included in these studies had two vessel disease and preserved left ventricular function, differing from the patients with AHF. Even so, there’s still no evidence of survival improvement when PCI was compared to CABG, especially in the long-term comparison. A recent multicenter prospective cohort study, The Korean Acute Heart Failure Registry, evaluated 5625 patients enrolled prospectively from March 2011 to February 2014[6]. In this analysis, 717 patients received CABG or PCI during the hospitalization for AHF. Adverse outcomes (death, ischemic stroke and a composite EDITORIAL

Coronary Artery Bypass Grafting in Acute Ischemic Heart Failure: Where do We Stand? (And Where Should We Go?)