not anatomically or functionally significant (eg, <70% diameter non left main coronary artery stenosis, frac- tional flow reserve >0.80, no or only mild ischemia on noninvasive testing), involve only the left circumflex or right coronary artery, or subtend only a small area of viable myocardium.318,341,348,349,382 386 (Level of Evi- dence: B) 3.3. Revascularization to Improve Symptoms: Recommendations Class I 1. CABG or PCI to improve symptoms is beneficial in patients with 1 or more significant (>70% diameter) coronary artery stenoses amenable to revasculariza- tion and unacceptable angina despite GDMT.370,387 396 (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 associated with ischemia, and unacceptable angina despite GDMT.374,377,380 (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.320,334,343,359 360 (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.381 (Level of Evidence: C) 2. Transmyocardial laser revascularization (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.397 401 (Level of Evidence: B) Class III: HARM 1. 