With refinements in CABG surgery over the past twenty years, operative myocardial revascularization is feasible in most patients with myocardial ischemia. Several multicenter, randomized trials have been reported, comparing medical with surgical management in patients with coronary artery disease. Based on the three largest trials and an extensive observational literature, a consensus appears to be emerging regarding the circumstances under which medical or surgical management appears to be the method of choice.