The current session of American Heart Association in Philadelphia (November 16-18, 2019) was marked by considerable buzz around the presentation of International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and its sub studies including quality of life and chronic kidney disease patients. The slides are available for review on ischemiatrial.org albeit the full text of the publication is awaited. The excitement around the trial is understandable; the data surrounding revcascularization in stable coronary artery disease is derived from historical studies, some of which were published over 20 years ago1.