Coronary revascularization has matured as a fi eld since coronary artery bypass grafting (CABG) was fi rst developed over 50 years ago, with diagnostic and treatment methods having advanced dramatically. CABG remains the standard of care for obstructive coronary artery disease, particularly for patients with multivessel disease or diabetes. It is now recognized that not all CABG is created equal-operative strategy, including conduit choice for bypass grafts and target coronary selection, affects survival. A multidisciplinary approach including surgeons with a special interest in CABG is recommended to optimize treatment selection and outcomes. KEY POINTSThe main criteria guiding the selection of revascularization therapy are disease stability, procedural risk, patient comorbidities, atherosclerotic burden, and lesion complexity.In general, CABG is preferred over percutaneous coronary intervention in patients with a heavy atherosclerotic burden and diabetes, and those without multiple signifi cant baseline comorbidities, frailty, or short life expectancy. CABG with arterial grafts can improve patient longevity, particularly with appropriate patient and coronary artery target selection.Multiple arterial grafts should be considered over single thoracic artery and multiple vein conduits.Less-invasive strategies are emerging.Guideline-directed medical therapy in coronary artery disease is essential for improved outcomes in primary and secondary prevention.