In part this is due to the difficulty of blinding both patients and healthcare providers. Twenty-six patients with severe angina resistant to standard medical therapy were studied in one of the first randomized trials comparing acupuncture and sham acupuncture.917 There was no differ- ence between groups in the frequency of angina or use of nitroglycerin, although patients treated with acupuncture achieved a higher pressure rate product on exercise testing. A subsequent study by the same investigators in patients with less severe ischemia failed to show a difference in either exercise variables or subjective measures between acupunc- ture and placebo patients.916 In contrast, a decrease in anginal episodes and an increase in the workload required to induce ischemia were observed with acupuncture in a crossover study of 21 patients with stable angina. The control condition in this trial was a pill placebo, however, so neither subjects nor investigators were blinded.948 In summary, acupuncture has not been studied sufficiently to warrant recommendation as a treatment option for relief of symptoms in patients with SIHD. 5. CAD Revascularization Recommendations and text in this section are the result of extensive collaborative discussions between the PCI and CABG writing committees, as well as key members of the SIHD and UA/NSTEMI writing committees. Certain issues, such as older versus more contemporary studies, primary analyses versus subgroup analyses, and prospective versus post hoc analyses, have been carefully weighed in designating COR and LOE; they are addressed in the appropriate corre- sponding text. The goals of revascularization for patients with CAD are to 1) improve survival and 2) relieve symptoms. Revascularization recommendations in this section are based predominantly on studies of patients with symptomatic SIHD and should be interpreted in this context. 