PCI Versus Medical Therapy Although contemporary interventional treatments have low- ered the risk of restenosis compared with earlier techniques, meta-analyses have failed to show that the introduction of BMS confers a survival advantage over balloon angio- plasty117 119 or that the use of DES confers a survival advantage over BMS.119,120 No study to date has demonstrated that PCI in patients with SIHD improves survival rates.26,53,56,82,116,119,121 124 Neither COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation)82 nor BARI 2D,116 which treated all patients with contemporary optimal medical ther- apy, demonstrated 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 acute coronary syndromes [ACS]) found a 20% reduction in death with PCI compared with medical therapy,123 2 other large analyses did not.119,122 An evaluation of 13 studies reporting the data from 5442 patients with nonacute CAD showed no advantage of PCI over medical therapy for the individual endpoints of all-cause death, cardiac death or MI, or nonfatal MI.124 Evaluation of 61 trials of PCI conducted over several decades shows that despite improvements in PCI technology and pharmacotherapy, PCI has not been demonstrated to reduce the risk of death or MI in patients without recent 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.82,99,104,107,108,125 PCI has not been demonstrated to improve survival in PCI may increase the short-term risk of MI.82,121,125,126 PCI does not lower the long-term risk of MI.82,116,119,121,122,126 2.6. 