Use revascularization by percutaneous catheter-based techniques or CABG when there is clear evidence of the potential to improve patients health status and survival. 4.2. General Approach to Therapy The writing committee has constructed these guidelines from the perspective that when making decisions about diagnostic tests and therapeutic interventions, their potential effects on improving survival and health status should be considered independently. Although treatment choices often are intended to achieve both goals simultaneously, circumstances exist in which a treatment is administered in pursuit of only one of these goals. For example, when pharmacotherapy such as aspirin or angiotensin-converting enzyme (ACE) inhibitors is prescribed, the goal is to improve survival but not necessarily quality of life. Similarly, revascularization can be performed to improve symptoms, even when there is no expectation of Figure 13. Cumulative incidence of MACE in patients with 3-vessel CAD based on SYNTAX score at 3-year follow-up in the SYNTAX trial treated with either CABG (blue) or PCI (gold). CABG indicates coronary artery bypass graft; CAD, coronary artery disease; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention; and SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery. Adapted from Kappetein.980 Figure 12. Nomogram for prediction of 5-year survival from clinical, physical examination, and cardiac catheterization findings. Asymp indicates asymptomatic; CAD, coronary artery disease; MI, myo- cardial infarction; and Symp, symptom- atic. Reproduced from Califf et al.55 improved survival. Occasionally, treatment recommendations related to achieving these goals can be at odds, such as when a patient is encouraged to take a medication that significantly reduces the risk of death even though it causes mild or moderate adverse side effects. It might also be the case that a patient expresses a preference for a treatment approach (eg, PCI) when the practitioner believes another approach (eg, GDMT) would be preferable. 