If the patient is at low or intermediate risk for mortality, therapeutic decisions should be directed toward improving symptoms and function, and catheterization may be deferred if symptoms can be controlled with medical therapy alone. For patients in whom angiography is performed and who are determined to be at low or intermediate risk, evidence reaffirms that it is safe to defer revascularization and institute a program of evidence-based medical therapy, because nei- ther survival nor adverse cardiac events are averted by proceeding immediately to revascularization.366,397,405 409 If a patient in this category has symptoms that are completely or almost completely relieved with medical therapy, it is usually prudent to continue with medical therapy without proceeding to revascularization. If symptoms persist, however, then a discus- sion with the patient to elicit his or her preferences and goals is necessary, along with a frank discussion of the benefits and risks of PCI and CABG, to ascertain whether the symptoms have been ameliorated sufficiently to warrant simply continuing with med- ical therapy alone (Figures 4 and 5). Coronary revascularization generally improves survival among certain subgroups of patients, particularly those with severe left main coronary stenosis. When revascularization is being considered on an elective basis solely for reducing the risk of death, the healthcare provider should engage the patient in an explicit consideration of the estimated improve- ment in survival relative to the potential risks and costs of the procedure and related interventions. Because reliable esti- mates of benefit, such as absolute risk reduction, are fre- quently unavailable for many specific subgroups, the risk for death can be estimated before treatment and the anticipated absolute risk reduction calculated (obtained by multiplying the RR reduction by the pretreatment risk). 