The committee noted that this clinically important reduction in mortality was only evident at the extended follow-up period of 9.8 years, with 30 day mortality in patients receiving CABG being substantially higher than those receiving medical therapy alone (estimate of 24 more per 1000, ranging from 4 more to 70 more). CABG was also associated with clinically important improvements in NYHA class and quality of life measured with EQ5D and the Kansas City Cardiomyopathy Questionnaire, though a smaller, not clinically important difference was found using the SF-12. These were notable given the invasive nature of the CABG procedure and the extended recovery period. Randomisation to receive CABG also led to fewer subsequent CABG and PCI procedures compared with patients randomised to medical therapy alone, though for subsequent PCI procedures the evidence was imprecise. For stroke, there appeared to be no clinically important difference between the groups, though the confidence intervals ranged from a clinically important benefit to a clinically important harm and so the committee was not confident in the effect estimate. In weighing up the benefits and harms of revascularisation, the evidence suggested that overall and in the long term, CABG led to improvements in critical outcomes for the people enrolled in the trial, albeit with substantial 30 day mortality. However, the committee had 2 serious concerns about the applicability of the evidence to modern clinical management of heart failure patients in the UK. The committee considered that the evidence for CABG was not generalisable to the majority of heart failure with reduced ejection fraction (HFREF) patients. The committee noted the evidence was based on a single trial ) and that the characteristics of the patients in that trial were not representative of the HFREF population in the UK community. 