The optimal treatment of chronic coronary syndromes (CCS) represents to date a matter of debate as revascularisation has not shown a real advantage over optimal medical therapy (OMT) alone on long-term overall survival, and has recently been reaffirmed in the latest guidelines as a useful strategy only in case of an ineffective response to OMT.1 Indeed, if the recently published ORBITA-2 trial demonstrated the benefit of revascularisation in relieving angina symptoms,2 many other trials aiming to show a benefit on hard outcomes have failed in their purpose. In many trials, revascularisation in addition to OMT was not effective in either improving survival or reducing adverse events compared with OMT alone, except for a subcohort of patients treated with coronary artery bypass grafting (CABG) in BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.3 The ISCHEMIA-EXTEND reported the extended follow-up of the recent ISCHEMIA trial showing in the group invasively treated at an average 7-year follow-up a significant reduction of cardiovascular mortality, which was however outweighed by the increase in non-cardiovascular mortality, resulting in no overall …