PCI with coronary stenting (BMS or DES) should not be performed if the patient is not likely to be able to tolerate and comply with DAPT for the appropri- ate duration of treatment based on the type of stent implanted.1110 1113 (Level of Evidence: B) The risk of stent thrombosis is increased dramatically in patients who prematurely discontinue DAPT, and stent thrombosis is associated with a mortality rate of 20% to 45%.1110 Because the risk of stent thrombosis with BMS is greatest in the first 14 to 30 days, this is the generally recommended minimum duration of DAPT therapy for these individuals. Consensus in clinical practice is to treat DES patients for $12 months with DAPT to avoid late (after 30 days) stent thrombosis.1110,1114 Therefore, the ability of the patient to tolerate and comply with $30 days of DAPT with BMS treatment and $12 months of DAPT with DES treat- ment is an important consideration in deciding whether to use PCI to treat patients with CAD. 5.10. Transmyocardial Revascularization A single randomized multicenter comparison of TMR (with a holmium:YAG laser) plus CABG and CABG alone in pa- tients in whom some myocardial segments were perfused by arteries considered not amenable to grafting1026 showed a significant reduction in perioperative mortality rate (1.5% versus 7.6%, respectively), and the survival benefit of the TMR CABG combination was present after 1 year of follow- up.1026 At the same time, a large retrospective analysis of data from the STS National Cardiac Database, as well as a study of 169 patients from the Washington Hospital Center who underwent combined TMR CABG, showed no difference in adjusted mortality rate compared with CABG alone.1027,1115 In short, a TMR CABG combination does not appear to improve survival compared with CABG alone. 