The treatment of ischemic heart disease by coronary artery bypass grafting remains under intense scrutiny. A better understanding of the long-term outcome for particular patient subgroups will allow a more appropriate choice to be made among the options of coronary artery bypass grafting, angioplasty, or continued medical management. Such information would also permit patients to make informed choices when their preferences influence the decision. A clearer understanding of the importance of risk-factor management (in particular lipid reduction by drug treatment) will improve the long-term results for patients undergoing surgical treatment (probably in both late mortality and late clinical events). Such an understanding can also clarify the need for further intervention.