Background: Heart attacks are the main cause of mortality globally and coronary artery disease (CAD) is a major contributor. One-third of deaths in both poor and industrialized countries among adults over the age of 35 can be attributed to coronary artery disease, with the number reaching close to 50% in western countries (according to some estimates). Objective: to evaluate treatment strategies for patients with obstructive CAD Patients and Methods: This was single center observational research evaluating 1283 patients admitted for elective coronary angiography for evaluation of patients with chronic coronary syndromes (CCS) in catheter (cath) Lab. in Cardiology Department in Mansoura Medical Specialized Hospital in the period between 01/10/2021 and 30/09/2022. Results: Mean age 57.9 and mean body mass index 30.07 and among the cases 972 of them were males with percentage (75.8%) and 311 females (24.2%) 807 were smokers (62.9%) and 897(69.9%) were hypertensive patients and 651(50.7%) diabetic and 421(32.8%) cases with dyslipidemia. Positive family history was seen in 287(22.4%) and 334 (26%) have heart failure. Regarding the treatment modality in the included cases, 80 of them treated with extensive medical treatment 6.2%, 935 treated with PCI 72.9% and 268 for CABG 20.9%. The study shows that the most affected artery was LAD followed by RCA then LCX and finally LM. The majority showed no LM affection 1106(86.2%) while 94(7.3%) with no significant stenosis and 83(6.5%) with significant stenosis. The study showed significant lower between medical group and CABG group in(BMI-Dyslipidemia–heart failure) The study showed significant lower between medical group and PCI group in (BMI) The study showed significant higher between CABG group and PCI group in (Age-Hypertension-Dyslipidemia-Heart failure). There are significantly higher among patients ≥ 65 Y more than group <65 in (sex female-hypertension-diabetes mellitus-dyslipidemia-heart failure) and significant lower in (sex male- family history) The study showed that SYNTAX score is directly proportional with Age , Male sex- Diabetes mellitus – hyper tension – heart failure). The study showed significant higher in Age and BMI and hypertension. Conclusions: In terms of death and disability-adjusted life years (DALYs) lost, CAD is by far the leading cause worldwide. In our study we had 1283 patients with obstructive coronary artery disease. Our treatment strategies were 935 patients in PCI, 268 patients in CABG and 80 patients in medical treatment. There was difference in number of vessels, SYNTAX score, presence of diabetes or not, symptoms and echocardiography finding.  Percent of PCI in cases with obstructive CAD was 72.9%, percent of medical treatment was 6.2% and CABG percent was 20.9%.The study showed that SYNTAX score is directly proportional with Age ,Male sex- diabetes mellitus – hyper tension – heart failure). There was significant lower between medical group and CABG group in(BMI-Dyslipidemia–heart failure