The cardiovascular field should be deservedly proud of the past 5 decades of progress in revascularization for coronary artery disease (CAD). Advances in coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) technology and technique, together with an abundance of data generated by high-quality clinical investigations, now provide a robust portfolio of options for obstructive CAD. Although management is often straightforward, in many cases the decision making is more complex due to a myriad of anatomic and clinical co-morbidities that may result in divergence of opinion. Recommendations are ultimately based on consideration of coronary complexity (Syntax score), need for adjunctive interventions (for valvular or aortic disease), and the presence of co-morbid conditions (Diabetes Mellitus, et al).