As a result, if CABG were to be compared with GDMT in RCTs today, the relative benefits for survival and angina relief observed several decades ago might no longer be observed. Con- versely, the concurrent administration of GDMT may sub- stantially improve long-term outcomes in patients treated with CABG in comparison with those receiving medical therapy alone. In the BARI 2D (Bypass Angioplasty Revas- cularization Investigation 2 Diabetes) trial of patients with diabetes mellitus, no significant difference in risk of mortality in the cohort of patients randomized to GDMT plus CABG or GDMT alone was observed, although the study was not powered for this endpoint, excluded patients with significant left main CAD, and included only a small percentage of patients with proximal LAD artery disease or LV ejection fraction (LVEF) 0.50.404 The PCI and CABG guideline writing committees endorse the performance of the ISCH- EMIA (International Study of Comparative Health Effective- ness with Medical and Invasive Approaches) trial, which will provide contemporary data on the optimal management strat- egy (medical therapy or revascularization with CABG or PCI) of patients with SIHD, including multivessel CAD, and moderate to severe ischemia. 3.5. 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 bare-metal stents (BMS) confers a survival advantage over balloon angioplasty405 407 or that the use of drug-eluting stents (DES) confers a survival advantage over BMS.407,408 No study to date has demonstrated that PCI in patients with SIHD improves survival rates.314,341,343,370,404,407,409 412 Nei- ther COURAGE (Clinical Outcomes Utilizing Revasculariza- tion and Aggressive Drug Evaluation)370 nor BARI 2D,404 which treated all patients with contemporary optimal medical therapy, demonstrated any survival advantage with PCI, although these trials were not specifically powered for this endpoint. 