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 Hillis et al 2011 ACCF/AHA CABG Guideline e671 compared with medical therapy,411 2 other large analyses did not.407,410 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.412 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 ACS.407 The findings from individual studies and systematic reviews of PCI versus medical therapy can be summarized as follows: PCI reduces the incidence of angina.370,387,392,395,396,413 PCI has not been demonstrated to improve survival in PCI may increase the short-term risk of MI.370,409,413,414 PCI does not lower the long-term risk of MI.370,404,407,409,410,414 3.6. CABG Versus PCI The results of 26 RCTs comparing CABG and PCI have been published: Of these, 9 compared CABG with balloon angio- plasty,363,393,415 429 14 compared CABG with BMS implanta- tion,376,430 447 and 3 compared CABG with DES 3.6.1. CABG Versus Balloon Angioplasty or BMS A systematic review of the 22 RCTs comparing CABG with balloon angioplasty or BMS implantation concluded the 1. Survival was similar for CABG and PCI (with balloon angioplasty or BMS) at 1 year and 5 years. Survival was similar for CABG and PCI in subjects with 1-vessel CAD (including those with disease of the proximal portion of the LAD artery) or multivessel CAD. 2. Incidence of MI was similar at 5 years after random- ization. 3. 