Randomized trials in stable ischemic heart disease (SIHD) show revascularization does not reduce death or myocardial infarction versus guideline-directed medical therapy, with benefit limited to symptom relief. This likely reflects lesion–ischemia mismatch, unclear ischemia origin, effective modern medical therapy, and trial design constraints. As a result, a prognostic advantage is difficult to demonstrate in broad SIHD populations. Exceptions where revascularization may improve outcomes include severe left main disease, significant left ventricle dysfunction, large ischemic burden, and refractory angina.

In this interview, Allen J. Taylor MD, FACC and Sanjay Kaul, MBBS examine ‘Why Can’t We Prove Revascularization Is Better Than Medical Therapy for SIHD?’