In a randomized trial, 2287 patients with coronary artery disease and evidence of ischemia were assigned to receive optimal medical therapy with or without percutaneous coronary intervention (PCI). At a median of 4.6 years, the rates of death and myocardial infarction were 19.0% in the PCI group and 18.5% in the medical-therapy group. The PCI group had lower rates of angina and repeat revascularization. Patients with coronary artery disease and evidence of ischemia were assigned to receive optimal medical therapy with or without percutaneous coronary intervention (PCI). At a median of 4.6 years, the rates of death and myocardial infarction were 19.0% in the PCI group and 18.5% in the medical-therapy group. During the past 30 years, the use of percutaneous coronary intervention (PCI) has become common in the initial management strategy for patients with stable coronary artery disease in North America, even though treatment guidelines advocate an initial approach with intensive medical therapy, a reduction of risk factors, and lifestyle intervention (known as optimal medical therapy). 1 , 2 In 2004, more than 1 million coronary stent procedures were performed in the United States, 3 and recent registry data indicate that approximately 85% of all PCI procedures are undertaken electively in patients with stable coronary artery disease. 4 PCI reduces the incidence of death and . . .