Coronary revascularization versus optimal medical therapy in elderly patients with stable angina

Multivessel coronary disease is more common in elderly patients. The question is which primary strategy should be chosen for elderly patients with stable angina, i.e., revascularization (percutaneous coronary intervention or coronary artery bypass surgery) with intensive pharmacological therapy and lifestyle changes (optimal medical therapy) or optimal medical therapy alone. Clinical trials that compare these two approaches showed that elderly patients benefit more from revascularization than younger patients. There is no doubt that multivessel disease requires a heart team to select the optimal strategy. Age itself is not a criterion for selecting optimal treatment strategies. One must consider many other factors, including medical findings, angiography, the patients’ wishes, social and cultural aspects, and other parameters. Patients should be given complete and objective information.