CABG or PCI to improve symptoms is beneficial in patients with 1 or more significant (>70% diameter) coronary artery stenoses amenable to revascularization and unacceptable angina despite GDMT.366,407,1012 1018,1020,1033 (Level of Evidence: A) Class IIa 1. CABG or PCI to improve symptoms is reasonable in patients with 1 or more significant (>70% diameter) coronary artery stenoses and unacceptable angina for whom GDMT cannot be implemented because of medication contraindications, adverse effects, or pa- tient preferences. (Level of Evidence: C) 2. PCI to improve symptoms is reasonable in patients with previous CABG, 1 or more significant (>70% diameter) coronary artery stenoses associ- ated with ischemia, and unacceptable angina despite GDMT.1021,1023,1024 (Level of Evidence: C) 3. It is reasonable to choose CABG over PCI to im- prove symptoms in patients with complex 3-vessel CAD (eg, SYNTAX score >22), with or without involvement of the proximal LAD artery, who are good candidates for CABG.964,980,987 989 (Level of Evidence: B) Class IIb 1. CABG to improve symptoms might be reasonable for patients with previous CABG, 1 or more signif- icant (>70% diameter) coronary artery stenoses not amenable to PCI, and unacceptable angina despite GDMT.1025 (Level of Evidence: C) 2. TMR performed as an adjunct to CABG to improve symptoms may be reasonable in patients with viable ischemic myocardium that is perfused by arteries that are not amenable to grafting.923,927,929,1026,1027 (Level of Evidence: B) Class III: Harm 1. CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (>50% diameter left main or >70% non left main stenosis diameter) or physiological (eg, abnormal FFR) criteria for revascularization. (Level of Evidence: C) 5.4. 