Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, necessitating innovative therapeutic strategies. Panax ginseng Meyer, esteemed in traditional Chinese medicine as the "King of Herbs," has garnered scientific attention for its cardiovascular benefits. Among its bioactive components, ginsenoside Rg1 stands out as a potent therapeutic candidate. This review consolidates current research on Rg1's multifaceted mechanisms in CAD management, including its roles in enhancing endothelial function, inhibiting smooth muscle cell proliferation, modulating inflammation, regulating lipid metabolism, preventing thrombosis, and promoting angiogenesis. Furthermore, Rg1 exhibits cardioprotective properties by mitigating ischemic myocardial injury, reducing myocardial hypertrophy, and preventing fibrosis. Despite promising preclinical findings, the clinical translation of Rg1 is hindered by challenges such as poor bioavailability, potential drug interactions, and limited clinical trial data. This review underscores the need for rigorous clinical studies to validate Rg1's efficacy and safety, paving the way for its incorporation into CAD therapeutic regimens.