PCI Versus Medical Therapy Although contemporary interventional treatments have low- ered the risk of restenosis compared with earlier techniques, meta-analyses have not shown that the introduction of bare metal stents (BMS) confers a survival advantage over balloon Fihn et al Stable Ischemic Heart Disease: Full Text e417 angioplasty1037 1039 or that the use of DES confers a survival advantage over BMS.138,1040 No study to date has demonstrated that PCI in patients with SIHD improves survival rates.138,366,408,959,985,987,1041 1044 Nei- ther COURAGE366 nor BARI 2D,408 which treated all pa- tients with contemporary optimal medical therapy, demon- strated any survival advantage with PCI, although these trials were not specifically powered for this endpoint. Although 1 large analysis evaluating 17 RCTs of PCI versus medical therapy (including 5 trials of subjects with ACS) found a 20% reduction in death with PCI compared with medical ther- apy,1043 2 other large analyses did not.138,1042 An evaluation of 13 studies reporting the data from 5442 patients with non- acute CAD showed no advantage of PCI over medical therapy for the individual endpoints of all-cause death, cardiac death or MI, or nonfatal MI.1044 Evaluation of 61 trials of PCI conducted over several decades shows that despite improvements in PCI technology and pharmacother- apy, PCI has not been demonstrated to reduce the risk of death or MI in patients without recent ACS.138 The findings from individual studies and systematic re- views of PCI versus medical therapy can be summarized as follows: PCI reduces the incidence of angina.366,407,1016,1020,1033,1045 PCI has not been demonstrated to improve survival in PCI may increase the short-term risk of MI.366,397,1041,1045 PCI does not lower the long-term risk of 5.6. 