Several randomized trials have been performed comparing medical management with surgery, medical management with angioplasty, and angioplasty with surgery for patients with stable angina. They were conducted in parallel with the progress of the revascularization techniques and as such, each of them reflects the prevailing practice of its time. Percutaneous revascularization and, to a lesser extent, coronary surgery have been, and it seems they will continue to be, rapidly evolving specialities. Medical management has also improved and future advances are likely to occur. One of the most remarkable advances in medical management is a new concept in metabolic approach in the treatment of angina pectoris. Despite the complexity of drawing conclusions from trials that compared approaches already outperformed in current practice, in this paper we review the relevant literature in an attempt to outline the comparative efficacy of the available treatment strategies.