The American College of Cardiology and American Heart Association (ACC/AHA) Task Force on Practice Guidelines (1991) Committee on Revision of Guidelines for Coronary Artery Bypass Surgery) reported that for patients with known or suspected coronary artery disease, diagnosis and treatment should be reasonable. This is because coronary artery bypass surgery is the most common procedure in the world and has more medical costs than any other procedure in cardiovascular disease. The earliest guidelines were published in 1991, and because of the tremendous advances in the surgical treatment of coronary artery disease, disease prevention, medications, and percutaneous transluminal angioplasty (PTCA), the committee revised the coronary artery bypass graft guidelines in a new era based on the medical literature since 1989. The guidelines have the role of administrative decision making and clinical recommendation for use or implementation. This report is divided into ten sections: after discussing the prognostic factors affecting surgical treatment, analyzing and comparing the outcomes of medical treatment and surgery, PTCA and surgery, and the cost-benefit relationship of bypass surgery, it proposes clinical management strategies for specific patient groups and lists eight categories of indications for the new coronary artery bypass surgery based on a hierarchy: A. Asymptomatic Indications for coronary artery bypass grafting (CABG) in patients with asymptomatic or mild angina: Class I ① significant left main stenosis; ② equivalent to left main stenosis, i.e. significant stenosis of the left anterior descending (LAD) and gyrus branches; ③ 3-vessel lesion [patients with abnormal left ventricular function such as ejection fraction (EF) less than 0.50 have a greater survival benefit] Class IIa proximal LAD stenosis with 1- to 2-vessel lesion. Class IIb 1 to 2 vessel lesions without proximal LAD involvement. B. Indications for CABG in stable angina: Class I ① significant left main stenosis; ② equivalent to left main stenosis, that is, significant stenosis (70%) of the proximal LAD gyrus branch of the left anterior descending branch; ③ 3-vessel lesion (patients with abnormal left ventricular function such as EF <0.50 have a greater benefit for survival); ④ 2-vessel lesion with proximal LAD stenosis of the left anterior descending branch and EF <0.5; ⑤ 1 to 2 vascular lesions without proximal stenosis of the left anterior descending LAD, but noninvasive examination shows large survivable myocardium; 6) angina affecting life and work despite maximal medical treatment should be considered when there is an acceptable risk of surgery. If angina is atypical, evidence of objective myocardial ischemia should be obtained. Category IIa ① proximal LAD stenosis with 1 vessel lesion; ② 1 to 2 vessel lesions without significant proximal LAD stenosis, but noninvasive examination shows a moderate area of viable myocardium or the presence of myocardial ischemia. Category III ① 1 to 2 vessel lesions without significant proximal LAD stenosis, the patient has mild symptoms that may not be due to myocardial ischemia or has not received appropriate drug therapy, and noninvasive examination shows only a small area of viable myocardium or does not show myocardial ischemia; ② the degree of coronary stenosis is critical (50% to 60% stenosis outside the left main stem). and non-invasive examination did not show myocardial ischemia; (iii) meaningless coronary artery stenosis (less than 50%). C. Indications for CABG in unstable angina/no Q-wave infarction: Class I ① significant left main stenosis; ② equivalent to left main stenosis: i.e. LAD and proximal stenosis of the gyral branch (70%); ③ ongoing myocardial ischemia that has failed with maximal non-surgical treatment. Class IIa LAD proximal stenosis with 1 to 2 branch vasculopathy. Class IIb 2-vessel lesion not involving the proximal LAD. D. Indications for CABG in ST-segment elevation (Q-wave) infarction: Class I without Class IIa ongoing myocardial ischemia or infarction that has been ineffective with maximum non-surgical treatment. Class IIb ① progressive left ventricular pump failure with coronary stenosis endangering viable myocardium outside the initial infarcted region; ② early infarction (less than 6 to 12 hours) reperfusion with progressive ST-segment elevation. Class III ST-segment progressive elevation without continued myocardial ischemia in early reperfusion delay (>12 hours). E. Indications for CABG in reduced left ventricular function: Class I ① significant left main stenosis; ② equivalent to left main stenosis, i.e. proximal stenosis of the left anterior descending LAD and gyral branch (70%); ③ proximal stenosis of the LAD with 2 to 3 vascular lesions. Class IIa hypoplastic left ventricle with significant viable, noncontractile, bypassable myocardium without any of the above anatomic conditions. Class III LV hypofunction without partial ischemia and with significant evidence of bypassable, viable myocardium. F. Indications for CAPG in patients with life-threatening ventricular arrhythmias: Class I ① left main stenosis; ② 3 branch vessel lesions. Class IIa ① with fatal arrhythmia and bypassable 1- to 2-vessel lesions; ② proximal LAD stenosis with 2- to 3-vessel lesions. Category III arrhythmia due to scarring or no evidence of myocardial ischemia. G. Surgical indications for CABG after PTCA failure: Class I ① myocardium at risk of progressive ischemia or vascular occlusion; ② hemodynamic instability Class IIa ① foreign body located in a very important anatomical site; ② hemodynamic instability in patients with coagulation system damage and no history of sternotomy. Class IIb hemodynamically unstable in patients with coagulation system damage and a history of sternotomy. Class III ① no ischemia; ② cannot be bypassed due to vascular anatomy or vascular perfusion. H. Surgical indications for re-bypass: Category Ⅰ angina affecting life and work despite maximal medical treatment, if angina is atypical, objective evidence of myocardial ischemia should be obtained. Category IIa noninvasive examination shows a large area of threatened myocardium distal to the bypassable vessel. Class IIb ischemia in the non-LAD distribution area again with a patent internal mammary artery anastomosis to the LAD supplying to the functional myocardium and without active medical treatment or (and) after PTCA.