International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Left Ventricular Dysfunction Trial

Inclusion Criteria: * Left ventricular ejection fraction (LVEF) ≤ 40% within prior 6 months (any local measurement, made within the past 6 months using echocardiography, multigated acquisition (MUGA), computed tomography (CT) scanning, magnetic resonance imaging (MRI), or ventricular angiography is acceptable, provided no subsequent measurement above 40%) * Participants with multivessel CAD (defined as severe 3 vessel disease or 2 vessel disease including left anterior descending (LAD) artery disease) on coronary CT angiography (CCTA) or invasive coronary angiography * CAD amenable to either PCI or CABG as determined by the local heart team * Participant is willing to comply with all aspects of the protocol, including adherence to the assigned strategy, medical therapy and follow-up visits * Participant is able and willing to give written informed consent Exclusion Criteria: * Decompensated heart failure or cardiogenic shock in the past 48 hours prior to randomization * Concomitant significant valvular heart disease requiring surgery * Prior cardiac surgery * Dementia with loss of capacity to consent (clinically evident or previously diagnosed) * Stroke within the previous 6 months or spontaneous intracranial hemorrhage at any time * History of noncompliance with medical therapy * Life expectancy less than the duration of the trial due to non-cardiovascular comorbidity * Pregnancy (known to be pregnant; to be confirmed before randomization, if applicable)