Coronary surgery remains an important therapeutic option for coronary revascularization, particularly in the elderly with coronary disease, in whom recent studies have demonstrated improvement of quality of life and long-term survival compared with medical treatment. Morbidity and mortality in the elderly may be predicted by stratification of preoperative risk factors into scoring systems. Interim results from multicenter trials comparing coronary surgery and coronary angioplasty for the treatment of multivessel coronary disease suggest that coronary surgery may be better for symptom relief in angina, with fewer hospital admissions and therapeutic interventions. Surgery for single- or double-vessel disease is appropriate when initial attempts at revascularization by coronary angioplasty have failed. Coronary surgery may be a therapeutic option in the treatment of cardiogenic shock, particularly in the presence of three-vessel disease or the presence of complex lesions not amenable to angioplasty. Long-term survival after myocardial infarction may be improved by revascularization of the infarct-related artery. Recent studies of myocardial viability have examined the use of positron-emission tomography scanning to determine which patients may benefit most from myocardial revascularization.