It is remarkable that after dozens of randomized trials over a span of over 40 years there remains debate about the merits of revascularization for stable ischemic heart disease . Over this period, there have been dramatic changes in the procedures, with improved percutaneous intervention from balloon angioplasty to coronary stents to several generations of drug-eluting coronary stents. In the field of cardiac surgery, there has been improved cardioplegia, increased used of arterial grafts, and a focus by cardiac surgeons and the Society of Thoracic Surgeons on reducing peri-procedural complications .