Coronary artery disease (CAD) is a leading cause of mortality in the worldwide. Stable CAD usually leads to angina. For angina or related symptoms, the current guidelines suggest anti-anginal medications as the first line treatment. Four decades ago, percutaneous coronary intervention (PCI) was introduced to relieve angina in stable CAD. Physicians and patients are so confident that PCI provides symptomatic relief. However, while PCI reduces death and subsequent myocardial infarction (MI) in the setting of acute coronary syndrome, its role is less clear in stable CAD. Several randomized controlled trials (RCTs) have compared event rates between PCI and optimal medical therapy. The most prominent among them Clinical Outcomes Using Revascularisation and Aggressive Drug Evaluation (COURAGE), showed no evidence of reduced mortality.
　　Nevertheless, PCI is still commonly performed for stable CAD. Eventually, a 93 000 patient network meta-analysis managed to suggest survival benefit with PCI with new-generation drug-eluting stents. Recently, Reserve versus Angiography for Multivessel Evaluation II (FAME II) trial showed long-term benefits from PCI in patients with evidence of ischaemia defined as FFR ≤0.80. This allowed a clear advantage to be seen in death and MI in the subsequent time period. By 5 years, death was neutral but MI showed significant reduction in the PCI arm.
　　In conclusion, PCI is unlikely to ever be shown to reduce mortality for stable CAD, but the FAME II trial provides the first suggestion that it might reduce the total number of MI. The ongoing ISCHEMIA trial will resolve this definitively.