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. Although 1 large analysis evaluating 17 RCTs of PCI versus medical therapy (including 5 trials of subjects with ACS) found a 20% reduction in death with PCI Hillis et al 2011 ACCF/AHA CABG Guideline e671 compared with medical therapy,411 2 other large analyses did not.407,410 An evaluation of 13 studies reporting the data from 5442 patients with nonacute CAD showed no advantage of PCI over medical therapy for the individual endpoints of all-cause death, cardiac death or MI, or nonfatal MI.412 Evaluation of 61 trials of PCI conducted over several decades shows that despite improvements in PCI technology and pharmacotherapy, PCI has not been demonstrated to reduce the risk of death or MI in patients without recent ACS.407 The findings from individual studies and systematic reviews of PCI versus medical therapy can be summarized as follows: PCI reduces the incidence of angina.370,387,392,395,396,413 PCI has not been demonstrated to improve survival in PCI may increase the short-term risk of MI.370,409,413,414 PCI does not lower the long-term risk of MI.370,404,407,409,410,414 3.6. 