Background Currently, there is no significant difference between OMT versus OMTR on all-cause mortality in patients with IHD. There is no data in this region. Objectives Evaluate the impact of OMT versus OMTR on primary end point of allcause mortality in patients with IHD. Method Data was collected, retrospectively, from the electronic database for all patients with IHD (n=2,692) attending Cardiovascular Disease Management Program (CVDMP), KAMC-Riyadh, between April 2000 and October 2011. Patients with no follow-up visits (n=59), or had non obstructive CAD (n=280) were excluded. OMT is an integral component of routine care within CVDMP. Data was analyzed using SPSS. Results Mean age was 60±10 years, 22% were female, and average follow-up was 40±33 months. Baseline characteristics were similar for both groups with exception of LVEF which was 38% versus 46% (p<0.001), and documented heart failure (HF) 60% versus 31% (p<0.001), respectively in OMT and OMTR. Of the enrolled patients (n=2353), 86% (n=2031) underwent revascularization, while 14% (n=322) remained on OMT for the following reasons; 18% (n=59) refused intervention and 82% (n=263) were declined intervention by the treating team. All-cause mortality was 3.3% (n=87) in the total population; 2.2% (45/2031) in the OMTR group versus 11% (35/322) in the OMT group (P<0.0001). Conclusion Mortality was higher in OMT group, which had a higher prevalence of HF and lower baseline LVEF.