A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease

Inclusion Criteria:

   - 1. Age ≥ 21 years with angina and/or evidence of myocardial ischemia

   - 2. Three vessel CAD, defined as ≥ 50% diameter stenosis by visual estimation in each
   of the three major epicardial vessels or major side branches, but not involving left
   main coronary artery, and amenable to revascularization by both PCI and CABG as
   determined by the Heart Team. Patients with a non-dominant right coronary artery may
   be included if only the left anterior descending artery (LAD) and left circumflex have
   ≥50% stenosis

   - 3. Willing and able to provide informed, written consent

Exclusion Criteria:

   - 1. Requirement for other cardiac or non-cardiac surgical procedure (e.g., valve
   replacement, carotid revascularization)

   - 2. Cardiogenic shock and/or need for mechanical/pharmacologic hemodynamic support

   - 3. Recent STEMI (<5 days prior to randomization)

   - 4. Ongoing Non STEMI with biomarkers (cardiac troponin) still rising

   - 5. Known left ventricular ejection fraction <30%

   - 6. Life expectancy < 2 years

   - 7. Requiring renal replacement therapy

   - 8. Undergoing evaluation for organ transplantation

   - 9. Participation or planned participation in another clinical trial, except for
   observational registries

   - 10. Pregnancy

   - 11. Inability to take dual antiplatelet therapy for six months

   - 12. Previous CABG

   - 13. Left main disease requiring revascularization

   - 14. Extremely calcified or tortuous vessels precluding FFR measurement

   - 15. Any target lesion with in-stent drug-eluting stent restenosis