In this introductory review, William E Boden and Juan Carlos Kaski describe several key features of the ISCHEMIA Trial in depth. The authors summarise “the future of managing chronic stable angina and how best to synthesise recent clinical trials evidence with evolving CCS management guidelines”. Take-home message: CCS is multifactorial beyond coronary stenosis. 50 to 70 % of ischemic symptomatic CCS patients undergoing coronary angiography do not have obstructive coronary stenosis, especially women. Some patients are still symptomatic after revascularization. It is therefore important to consider the future of managing chronic stable angina.