Coronary artery disease is increasing in Taiwan in the past decades. Over half of the patients have multiple vessel disease. The choice of treatment in these patients between percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) should be based on the benefit-risk, economic issue, short-term morbidity and length of stay in hospital, and long-term repeat revascularization procedure(s). The OPTIMAL mechanical revascularization technique for multivessel coronary artery disease remains contentious in drug-eluting stent era. But we have more clinical trial data to answer the risk-benefit trade-off. Trends in Taiwan and even United States show that the volume of PCI has been increasing while CABG rates decline. These data indicate a growing preference for PCI over CABG for many patients and their physicians, especially for persons aged 65 and older. Current guideline suggests that patients with chronic stable angina who have one-vessel or two-vessel coronary artery disease without involvement of the left main or left anterior descending coronary arteries fare similarly regardless of treatment modality. In contrast, patients with multivessel disease and inducible ischemia are better served by revascularization by either CABG or PCI. In patients who have left main involvement, diffuse disease with severe atherosclerosis, diabetes mellitus, advanced age, or left ventricular dysfunction, the outcome with regard to survival, anginal relief, and freedom from additional intervention is better with CABG than with PCI. In real world practice, we have more concern between these principles and patients’ preference. Physician should provide Guideline’s suggestion, and let patients and their family make the choice of revascularization strategy.