Myocardial revascularization improves survival rates and quality of life for patients with symptomatic ischemic heart disease. The less severe the anatomic disease, the smaller the benefit, particularly for survival. Patients with more severe anatomic disease benefit from surgical therapy, in terms of both survival and quality of life. Continuing advances in pharmacological secondary prevention, percutaneous intervention, and surgical treatment mandate continued analysis of contemporary outcomes to provide the best information for rational decision-making.