This process complies with the Institute of Medicine s goals for transparently sharing evi- dence with patients so that they can control (or more actively participate in) their own decisions.411 In general, a beneficial effect of revascularization on survival has been demonstrated most clearly among patients with the highest cardiovascular risk.412 Although traditional methods of risk stratification have relied on coronary anatomy and LV function, other strategies described in this guideline can be used (Figure 5). The specific anatomic features of the patient and the likelihood of procedural success often influence the approach to a patient for whom revascularization is being considered. For example, a given patient with 1-vessel disease might have coronary anatomic features that would make the risk of PCI high enough and the likelihood of success low enough that CABG or medical therapy would be preferred. In general, complete revascularization leads to better outcomes than incomplete revascularization.413 418 In patients with chronic total occlusion, CABG could be preferable to PCI,419 but this is still controversial. Although the technology and techniques for PCI of chronic total occlusions are improving, there remains no current evidence that survival is improved after successful PCI of a chronic total occlusion. Some patients with diabetes mellitus can have such diffuse disease that neither CABG nor PCI is likely to produce sustained benefits. Other patients can have small-caliber arteries or diffuse disease that is likely to lead to early graft failure. Still others can have long, complex lesions that are very likely to undergo restenosis after PCI, although use of drug-eluting stents (DES) can reduce this risk. The majority of patients with SIHD have clinical features indicating that revascularization is unlikely to improve life expectancy or the risk of subsequent MI. 