myocardial ischemia (eg, high-risk criteria on stress testing, abnormal intracoronary hemodynamic eval- uation, or >20% perfusion defect by myocardial perfusion stress imaging) or target vessels supplying a large area of viable myocardium.60 63 (Level of Evidence: B) 2. CABG to improve survival is reasonable in patients with mild-moderate left ventricular (LV) systolic dysfunction (ejection fraction [EF] 35% to 50%) and significant (>70% diameter stenosis) multi-vessel CAD or proximal LAD coronary artery stenosis, when viable myocardium is present in the region of intended revascularization.30,64 68 (Level of Evi- dence: B) 3. CABG with a left internal mammary artery (LIMA) graft to improve survival is reasonable in patients with significant (>70% diameter) stenosis in the proximal LAD artery and evidence of extensive ischemia.30,56,69,70 (Level of Evidence: B) 4. It is reasonable to choose CABG over PCI to im- prove survival in patients with complex 3-vessel CAD (eg, SYNTAX score >22), with or without involvement of the proximal LAD artery who are good candidates for CABG.32,46,56,71,72 (Level of Evi- dence: B) 5. CABG is probably recommended in preference to PCI to improve survival in patients with multivessel CAD and diabetes mellitus, particularly if a LIMA graft can be anastomosed to the LAD artery.62,74 81 (Level of Evidence: B) Class IIb 1. The usefulness of CABG to improve survival is uncertain in patients with significant (>70%) diam- eter stenoses in 2 major coronary arteries not involv- ing the proximal LAD artery and without extensive ischemia.56 (Level of Evidence: C) 2. The usefulness of PCI to improve survival is uncer- tain in patients with 2- or 3-vessel CAD (with or without involvement of the proximal LAD artery) or 1-vessel proximal LAD disease.26,53,56,82 (Level of Evidence: B) 3. 