In the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) study, 454 patients at 16 VA hospitals with high-risk features for adverse outcome with surgery were randomized to either surgery or PCI. High-risk characteristics included prior open-heart surgery, age greater than 70 years, ejection fraction less than 0.35, MI within 7 days, and the need for an intra-aortic balloon pump (IABP). Stents were used in 54% of PCI patients. Survival was similar (79% with CABG and 80% with PCI) at 36 months 8. Finally, in the Stenting versus Internal Mammary Artery (SIMA) trial, 121 patients with isolated proximal left anterior descending coronary artery disease were randomly treated with stenting or CABG (using the IMA). At 2.4 years of follow-up, there were no differences in the rates of death, MI, functional class, medications, or quality of life. Repeat revascularization was required more often (31% versus 7%) in the stent group (9). Overall, 6 trials have now been published comparing CABG with PCI utilizing stents in single or multivessel disease. Compared with the earlier trials utilizing balloon angioplasty, stent usage and left IMA revascularization rates have increased (16- 26). The results in terms of death, MI, and stroke are similar in the more recent trials; however, the disparity in the need for repeat revascularization, which favors surgery, has narrowed (Table 1).