T he optimal treatment of patients with stable coronary artery disease (CAD) remains a matter of ongoing debate. Although revascularization provides an accepted symptomatic benefit, controversy lingers on its prognostic value when added to contemporary optimal medical care.1 Protagonists of medical therapy stress that revascularization, especially with percutaneous coronary intervention (PCI), does not reduce rates of death or myocardial infarction.2 Protagonists of mechanical therapy counter that most revascularization studies were based on anatomic guidance only, with visual estimation of stenosis severity from the coronary angiogram.3 Because ≤39% of angiographically obstructive coronary stenoses lack functional significance, no benefit should be expected from revascularizing nonischemic myocardium. 4 As a result, outcome results from existing trials are confounded by the neutral or negative effects arising from unnecessary interventions.