The management of stable ischemic heart disease (SIHD) leading to ischemic cardiomyopathy (ICM) has been the focus of attention in the field of cardiology in more recent years, with numerous trials providing conflicting data regarding benefits of medical therapy versus revascularization, whether surgical or interventional. Herein we aim to review and analyze pivotal trials in management of SIHD in ICM, as well as explore the role of additional investigational testing such as viability studies as well as therapeutic modalities such as mechanical circulatory support in the management of this patient population.