World Health Organization. Global Status Report on Noncommunicable Diseases 2010 (WHO, 2011).
Lozano, R. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095–2128 (2012).
Google Scholar
Boden, W. E. et al. Myocardial ischemic syndromes: a new nomenclature to harmonize evolving international clinical practice guidelines. Circulation 150, 1631–1637 (2024).
Google Scholar
Ryan, T. J. The coronary angiogram and its seminal contributions to cardiovascular medicine over five decades. Circulation 106, 752–756 (2002).
Google Scholar
Cannon, C. P. et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N. Engl. J. Med. 344, 1879–1887 (2001).
Google Scholar
Keeley, E. C., Boura, J. A. & Grines, C. L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361, 13–20 (2003).
Google Scholar
Kushner, F. G. et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 54, 2205–2241 (2009).
Google Scholar
Mehta, S. R. et al. Early versus delayed invasive intervention in acute coronary syndromes. N. Engl. J. Med. 360, 2165–2175 (2009).
Google Scholar
Doenst, T. et al. PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. J. Am. Coll. Cardiol. 73, 964–976 (2019).
Google Scholar
Doenst, T., Bonow, R. O., Bhatt, D. L., Falk, V. & Gaudino, M. Improving terminology to describe coronary artery procedures: JACC review topic of the week. J. Am. Coll. Cardiol. 78, 180–188 (2021).
Google Scholar
Fearon, W. F. et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N. Engl. J. Med. 86, 128–137 (2022).
Google Scholar
Head, S. J. et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 391, 939–948 (2018).
Google Scholar
Serruys, P. W. et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 360, 961–972 (2009).
Google Scholar
Farkouh, M. E. et al. Strategies for multivessel revascularization in patients with diabetes. N. Engl. J. Med. 367, 2375–2384 (2012).
Google Scholar
Sabatine, M. S. et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet 398, 2247–2257 (2021).
Google Scholar
Boden, W. E., Kaski, J. C., Al-Lamee, R. & Weintraub, W. S. What constitutes an appropriate empirical trial of antianginal therapy in patients with stable angina before referral for revascularisation? Lancet 399, 691–694 (2022).
Google Scholar
Maron, D. J. et al. Initial invasive or conservative strategy for stable coronary disease. N. Engl. J. Med. 382, 1395–1407 (2020).
Google Scholar
Spertus, J. A. et al. Health-status outcomes with invasive or conservative care in coronary disease. N. Engl. J. Med. 382, 1408–1419 (2020).
Google Scholar
Hochman, J. S. et al. Survival after invasive or conservative management of stable coronary disease. Circulation 147, 8–19 (2023).
Google Scholar
Perera, D. et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N. Engl. J. Med. 387, 1351–1360 (2022).
Google Scholar
Velazquez, E. J. et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N. Engl. J. Med. 364, 1607–1616 (2011).
Google Scholar
Bonow, R. O. et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N. Engl. J. Med. 364, 1617–1625 (2011).
Google Scholar
Velazquez, E. J. et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N. Engl. J. Med. 374, 1511–1520 (2016).
Google Scholar
Al-Lamee, R. et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 391, 31–40 (2018).
Google Scholar
Rajkumar, C. A. et al. A placebo-controlled trial of percutaneous coronary intervention for stable angina. N. Engl. J. Med. 389, 2319–2330 (2023).
Google Scholar
Park, S.-J. et al. Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. Lancet 403, 1753–1765 (2024).
Google Scholar
Lin, G. A. & Dudley, R. A. Fighting the “oculostenotic reflex”. JAMA Intern. Med. 174, 1621–1622 (2014).
Google Scholar
Chacko, L. et al. Effects of percutaneous coronary intervention on death and myocardial infarction stratified by stable and unstable coronary artery disease. Circ. Cardiovasc. Qual. Outcomes 13, e006363 (2020).
Google Scholar
Stergiopoulos, K. et al. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern. Med. 174, 232–240 (2014).
Google Scholar
Shah, R. et al. A meta-analysis of optimal medical therapy with or without percutaneous coronary intervention in patients with stable coronary artery disease. Coron. Artery Dis. 33, 91–97 (2022).
Google Scholar
Hueb, W. A. et al. The Medicine, Angioplasty or Surgery Study (MASS): a prospective, randomized trial of medical therapy, balloon angioplasty or bypass surgery for single proximal left anterior descending artery stenoses. J. Am. Coll. Cardiol. 26, 1600–1605 (1995).
Google Scholar
RITA-2 trial participants Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. Lancet 350, 461–468 (1997).
Google Scholar
Henderson, R. A. et al. Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy. J. Am. Coll. Cardiol. 42, 1161–1170 (2003).
Google Scholar
Pitt, B. et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N. Engl. J. Med. 341, 70–76 (1999).
Google Scholar
Davies, R. F. et al. Asymptomatic cardiac ischemia pilot (ACIP) study two-year follow-up. Circulation 95, 2037–2043 (1997).
Google Scholar
Boden, W. E. et al. Optimal medical therapy with or without PCI for stable coronary disease. N. Engl. J. Med. 356, 1503–1516 (2007).
Google Scholar
Sedlis Steven, P. et al. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N. Engl. J. Med. 373, 1937–1946 (2015).
Google Scholar
Frye, R. L. et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N. Engl. J. Med. 360, 2503–2515 (2009).
Google Scholar
The BARI Investigators Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 96, 1761–1769 (1997).
Google Scholar
Everett, B. M. et al. Troponin and cardiac events in stable ischemic heart disease and diabetes. N. Engl. J. Med. 373, 610–620 (2015).
Google Scholar
De Bruyne, B. et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N. Engl. J. Med. 367, 991–1001 (2012).
Google Scholar
Stone, G. W. et al. Medical therapy with versus without revascularization in stable patients with moderate and severe ischemia: the case for community equipoise. J. Am. Coll. Cardiol. 67, 81–99 (2016).
Google Scholar
Kereiakes, D. J. et al. The truth and consequences of the COURAGE trial. J. Am. Coll. Cardiol. 50, 1598–1603 (2007).
Google Scholar
Xaplanteris, P. et al. Five-year outcomes with PCI guided by fractional flow reserve. N. Engl. J. Med. 379, 250–259 (2018).
Google Scholar
Sidhu, M. S. et al. Causes of cardiovascular and noncardiovascular death in the ISCHEMIA trial. Am. Heart J. 248, 72–83 (2022).
Google Scholar
Ma, J. et al. Association between stent implantation and progression of nontarget lesions in a rabbit model of atherosclerosis. Circ. Cardiovasc. Interv. 14, e010764 (2021).
Google Scholar
Reynolds, H. R. et al. Outcomes in the ISCHEMIA trial based on coronary artery disease and ischemia severity. Circulation 144, 1024–1038 (2021).
Google Scholar
Bangalore, S. et al. Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial. EuroIntervention 20, e1276–e1287 (2024).
Google Scholar
Doenst, T., Borger, M., Falk, V. & Milojevic, M. ESC/EACTS guideline for chronic coronary syndrome-invasive treatment perspectives important for daily practice. Eur. J. Cardiothorac. Surg. 66, ezae360 (2024).
Google Scholar
Dimagli, A. et al. Quality of life after percutaneous coronary intervention versus coronary artery bypass grafting. J. Am. Heart Assoc. 12, e030069 (2023).
Google Scholar
Parisi, A. F., Folland, E. D. & Hartigan, P. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators. N. Engl. J. Med. 326, 10–16 (1992).
Google Scholar
The TIME Investigators Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet 358, 951–957 (2001).
Google Scholar
Maron, D. J. et al. Impact of an initial strategy of medical therapy without percutaneous coronary intervention in high-risk patients from the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial. Am. J. Cardiol. 104, 1055–1062 (2009).
Google Scholar
Nguyen, D. D. et al. Health status and clinical outcomes in older adults with chronic coronary disease. J. Am. Coll. Cardiol. 81, 1697–1709 (2023).
Google Scholar
Mavromatis, K. et al. Complete revascularization and angina-related health status in the ischemia trial. J. Am. Coll. Cardiol. 82, 295–313 (2023).
Google Scholar
Kaptchuk, T. J., Goldman, P., Stone, D. A. & Stason, W. B. Do medical devices have enhanced placebo effects? J. Clin. Epidemiol. 53, 786–792 (2000).
Google Scholar
Foley, M. J. et al. Fractional flow reserve and instantaneous wave-free ratio as predictors of the placebo-controlled response to percutaneous coronary intervention in stable coronary artery disease. Circulation 151, 202–214 (2025).
Google Scholar
Abdallah, M. S. et al. Quality of life after surgery or DES in patients with 3-vessel or left main disease. J. Am. Coll. Cardiol. 69, 2039–2050 (2017).
Google Scholar
Ahmed-Jushuf, F. et al. Ischemia on dobutamine stress echocardiography predicts efficacy of PCI. J. Am. Coll. Cardiol. 85, 1740–1753 (2025).
Google Scholar
Stone, G. W. et al. A Prospective natural-history study of coronary atherosclerosis. N. Engl. J. Med. 364, 226–235 (2011).
Google Scholar
US National Library of Medicine. ClinicalTrials.gov (2025).
US National Library of Medicine. ClinicalTrials.gov (2025).
US National Library of Medicine. ClinicalTrials.gov (2022).
Takaro, T., Hultgren, H. N., Lipton, M. J. & Detre, K. M. The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions. Circulation 54, III107–III117 (1976).
Google Scholar
Kirov, H. et al. Comparing percutaneous coronary intervention and coronary artery bypass grafting for left main stenosis on the basis of current regional registry evidence. JTCVS Open. 22, 257–271 (2024).
Google Scholar
Ramadan, R., Boden, W. E. & Kinlay, S. Management of left main coronary artery disease. J. Am. Heart Assoc. 7, e008151 (2018).
Google Scholar
Arbab-Zadeh, A. et al. Left main disease — the last frontier for medical therapy in stable coronary artery disease? Eur. Cardiol. 20, e24 (2025).
Google Scholar
The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N. Engl. J. Med. 311, 1333–1339 (1984).
Google Scholar
European Coronary Surgery Study Group. Coronary-artery bypass surgery in stable angina pectoris: survival at two years. Lancet 1, 889–893 (1979).
European Coronary Surgery Study Group. Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Lancet 2, 1173–1180 (1982).
Alderman, E. L. et al. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation 82, 1629–1646 (1990).
Google Scholar
Hueb, W. et al. The medicine, angioplasty, or surgery study (MASS-II): a randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease: one-year results. J. Am. Coll. Cardiol. 43, 1743–1751 (2004).
Google Scholar
Stone, G. W. et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N. Engl. J. Med. 375, 2223–2235 (2016).
Google Scholar
Mäkikallio, T. et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 388, 2743–2752 (2016).
Google Scholar
Kang, S. H. et al. Differential event rates and independent predictors of long-term major cardiovascular events and death in 5795 patients with unprotected left main coronary artery disease treated with stents, bypass surgery, or medication. Circ. Cardiovasc. Interv. 10, e004988 (2017).
Google Scholar
Perera, D. et al. Viability and outcomes with revascularization or medical therapy in ischemic ventricular dysfunction: a prespecified secondary analysis of the REVIVED-BCIS2 trial. JAMA Cardiol. 8, 1154–1161 (2023).
Google Scholar
Ryan, M. et al. Medical therapy and outcomes in REVIVED-BCIS2 and STICHES: an individual patient data analysis. Eur. Heart J. 46, 2052–2062 (2025).
Google Scholar
Liga, R., Colli, A., Taggart, D. P., Boden, W. E. & De Caterina, R. Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how. J. Am. Heart Assoc. 12, e026943 (2023).
Google Scholar
Fremes, S. E. et al. STICH3C: rationale and study protocol. Circ. Cardiovasc. Interv. 16, e012527 (2023).
Google Scholar
Ezad, S. M. et al. Impact of anatomical and viability-guided completeness of revascularization on clinical outcomes in ischemic cardiomyopathy. J. Am. Coll. Cardiol. 84, 340–350 (2024).
Google Scholar
El Bèze, N. & Steg, P. G. Heart failure and revascularization: which method to choose and should we even do it? Eur. Heart J. 46, 81–83 (2025).
Google Scholar
Newman, J. D. et al. Outcomes of participants with diabetes in the ISCHEMIA trials. Circulation 144, 1380–1395 (2021).
Google Scholar
Virani, S. S. et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 148, e9–e119 (2023).
Google Scholar
Aggarwal, R., Chiu, N., Pankayatselvan, V., Shen, C. & Yeh, R. Prevalence of angina and use of medical therapy among US adults: a nationally representative estimate. Am. Heart J. 228, 44–46 (2020).
Google Scholar
De Caterina, R., Bhatt, D. L. & Boden, W. E. Optimal medical therapy for initial management of stable angina: a call to action. Eur. Heart J. (2025).
Google Scholar
Nguyen, D. D. et al. Developing an individualized patient decision aid for chronic coronary disease based on the ISCHEMIA trial: a mixed-methods study. Circ. Cardiovasc. Qual. Outcomes 17, e010923 (2024).
Google Scholar
Nishigaki, K. et al. Percutaneous coronary intervention plus medical therapy reduces the incidence of acute coronary syndrome more effectively than nitial medical therapy only among patients with low-risk coronary artery disease: a randomized, comparative, multicenter study. JACC Cardiovasc. Interv. 1, 469–479 (2008).
Google Scholar
Folland, E. D., Hartigan, P. M. & Parisi, A. F. Percutaneous transluminal coronary angioplasty versus medical therapy for stable angina pectoris: outcomes for patients with double-vessel versus single-vessel coronary artery disease in a Veterans Affairs cooperative randomized trial. J. Am. Coll. Cardiol. 29, 1505–1511 (1997).
Google Scholar
CASS Principal Investigators and their associates. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation 68, 939–950 (1983).
Google Scholar
Goy, J. J. et al. A prospective randomized trial comparing stenting to internal mammary artery grafting for proximal, isolated de novo left anterior coronary artery stenosis: the SIMA trial. Stenting vs internal mammary artery. Mayo Clin. Proc. 75, 1116–1123 (2000).
Google Scholar
Morrison, D. A. et al. Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. J. Am. Coll. Cardiol. 38, 143–149 (2001).
Google Scholar
Diegeler, A. et al. Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery. N. Engl. J. Med. 347, 561–566 (2002).
Google Scholar
Drenth, D. J. et al. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: six months’ angiographic and clinical follow-up of a prospective randomized study. J. Thorac. Cardiovasc. Surg. 124, 130–135 (2002).
Google Scholar
Rodriguez, A. E. et al. Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J. Am. Coll. Cardiol. 46, 582–588 (2005).
Google Scholar
Hong, S. J. et al. Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis. Catheter. Cardiovasc. Interv. 64, 75–81 (2005).
Google Scholar
Kapur, A. et al. Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J. Am. Coll. Cardiol. 55, 432–440 (2010).
Google Scholar
Serruys, P. W. et al. 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J. Am. Coll. Cardiol. 55, 1093–1101 (2010).
Google Scholar
Boudriot, E. et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J. Am. Coll. Cardiol. 57, 538–545 (2011).
Google Scholar
Kamalesh, M. et al. Percutaneous coronary intervention versus coronary bypass surgery in United States veterans with diabetes. J. Am. Coll. Cardiol. 61, 808–816 (2013).
Google Scholar
Head, S. J. et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur. Heart J. 35, 2821–2830 (2014).
Google Scholar
Morice, M.-C. et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 129, 2388–2394 (2014).
Google Scholar
Park, S.-J. et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N. Engl. J. Med. 372, 1204–1212 (2015).
Google Scholar
Ahn, J.-M. et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: 5-year outcomes of the PRECOMBAT study. J. Am. Coll. Cardiol. 65, 2198–2206 (2015).
Google Scholar
Blazek, S. et al. Comparison of sirolimus-eluting stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 7-year follow-up of a randomized trial. JACC Cardiovasc. Interv. 8, 30–38 (2015).
Google Scholar
Buszman, P. E. et al. Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (Left Main Coronary Artery Stenting) LE MANS trial. JACC Cardiovasc. Interv. 9, 318–327 (2016).
Google Scholar
Brandão, S. M. G. et al. Utility and quality-adjusted life-years in coronary artery disease: Five-year follow-up of the MASS II trial. Medicine 96, e9113 (2017).
Google Scholar
Thuijs, D. J. F. M. et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 394, 1325–1334 (2019).
Google Scholar
Farkouh, M. E. et al. Long-term survival following multivessel revascularization in patients with diabetes: the FREEDOM follow-on study. J. Am. Coll. Cardiol. 73, 629–638 (2019).
Google Scholar
Serruys, P. W. et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J. Am. Coll. Cardiol. 46, 575–581 (2005).
Google Scholar
SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet 360, 965–970 (2002).
Google Scholar
link
