The rapid evolution of medical therapy, percutaneous coronary interventional techniques and cardiac surgery along with the changing patient profile over the last few decades has required the clinician to make increasingly complex decisions. This has led to significant variations in practices that may be discordant with evidence based clinical practice guidelines. Such variations have an unclear clinical impact. There is hope that with growing efforts to apply multidisciplinary care to the management of complex coronary artery disease (CAD),that we will arrive at more consistent and balanced decisions.