Background Over the past two decades, increased understanding of coronary artery disease, coupled with advances in relevant treatment techniques, has led to significant improvements in outcomes for patients with severe coronary artery disease. The American College of Cardiology Foundation (ACCF) recently published an evidence-based reassessment of the efficacy of coronary artery bypass grafting (CABG) to guide clinical decision making. Conclusions CABG significantly reduces the need for revascularization compared with percutaneous coronary intervention (PCI) within 1 year after surgery (less than 5% vs. nearly 25%), and this advantage continues up to 5 years after surgery (10% vs. 45%). Patients with diabetes, in particular, have a higher survival rate after CABG than PCI. Although PCI relieves angina symptoms, it does not improve survival or avoid myocardial infarction (MI) in patients who have not recently developed an acute coronary syndrome. Meta-analysis showed that bare metal stents did not improve patient survival compared with balloon angioplasty. Similarly, drug-eluting stents did not improve patient survival compared with bare metal stents. At 10 years after CABG, the patency rate of internal mammary artery grafts was over 90%, and only 1% developed significant atherosclerotic stenosis. Bilateral internal mammary artery grafts improve cardiovascular outcomes in patients, but may be at higher risk for sternal wound infection in obese and diabetic patients. Occlusion occurs in approximately 25% of patients within 1 year after saphenous vein grafting, with annual occlusion rates of 1% to 2% within 5 years and 4% to 5% between 5 and 10 years. after 10 years, approximately half of saphenous vein grafts remain patent, while the other half develop atherosclerosis. The radial artery is more muscular and more prone to spasm, with an occlusion rate of more than 70%, and is only indicated for lesions located on the left side. The 1-year patency rate is higher with CABG under extracorporeal circulation compared with CABG under non-inhalation circulation, and neuropsychiatric outcomes as well as resource use are comparable for both. Inhalation anesthesia not only improves intracardiac blood flow compared to non-inhalation anesthesia, but also awakens quickly after extubation. As long as there are no contraindications (e.g., history of previous radiation injury or other special circumstances limiting blood flow), it is recommended that the left internal mammary artery be chosen to establish a left anterior descending bypass. Since slow flow means a high risk of graft occlusion, arterial grafts should not be used to establish a right coronary bypass unless the stenosis is severe. Coronary stenting should not be used in patients who cannot adhere to or tolerate dual antiplatelet therapy (DAPT) because of the high risk of re-embolization and thus mortality: at least 30 d of DAPT for bare metal stents and at least 1 year of DAPT for drug-eluting stents. Aspirin 100-325 mg/d should be given throughout the perioperative period to reduce the risk of bleeding and improve patient outcomes. Aspirin is usually started within 6 h postoperatively, which improves the patency of the saphenous vein graft. Aspirin at doses less than 100 mg, although effective in patients with coronary artery disease, is less effective in maintaining saphenous vein patency. Thienopyridines, such as clopidogrel and ticagrelor, are best discontinued 5 d before CABG; they are absolutely contraindicated for 24 h before surgery to avoid the risk of bleeding. Prasugrel, on the other hand, should be discontinued at least 7 d prior to surgery. All patients should receive statins in the perioperative period. Studies have shown that patients not treated with statins have a higher chance of cardiovascular complications after CABG. Perioperative use of beta-blockers reduces the incidence of CABG-related atrial fibrillation and its effects. Short- or long-term use of β-blockers also reduces the risk of ischemia and death. Patients with diabetes mellitus should receive continuous insulin infusion after surgery in order to control blood glucose below 180 mg/dl. For the time being, it is less clear how valuable it really is to control blood glucose at the target level of 140 mg/dl. Peri-aortic ultrasonography is superior to palpation or transesophageal ultrasonography in detecting the location and severity of ascending aortic atherosclerosis. Ascending aortic atherosclerosis poses a risk of perioperative stroke in patients with CABG. CABG should not be performed in patients with persistent ventricular tachycardia with myocardial scarring but no current evidence of ischemia. All patients should be considered for postoperative cardiac rehabilitation. Rehabilitation therapy usually begins 1 month after surgery, 3 times a week for 3 months, and can improve the patient’s exercise tolerance by about 1/3.