Sameer Satija, MD, Clinical Fellow, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Nanette K. Wenger, MD, Professor of Medicine (Cardiology), Emory University School of Medicine, Atlanta; Chief of Cardiology, Grady Memorial Hospital, Atlanta, GA, USA.

Chronic angina is a common problem among older adults. The burden of coronary heart disease in patients over age 75 is high. Coronary angiography, percutaneous coronary intervention with or without stenting, and coronary artery bypass graft surgery all entail higher risk in the older population. Nevertheless, patients older than 75 also may accrue a greater benefit, given their increased risk for overall cardiac mortality. We suggest a measured approach to revascularization in older adults with chronic angina, considering their severity of symptoms, the adequacy of treatment of angina, their left ventricular ejection fraction, patient preference, other comorbidities, and ischemic burden identified by noninvasive testing.
Key words: angina, revascularization, older adults, coronary disease, coronary angiography.

Paul WM Fedak, MD

Myocardial revascularization is a scarce resource where demand exceeds supply. Waiting lists for these procedures are increasingly lengthy and the growing elderly population with advanced coronary artery disease (CAD) challenges physicians to consider the appropriateness of our contemporary revascularization procedures. Despite the current period of accelerating resource demands, resource allocation decisions regarding myocardial revascularization should not be made on the basis of age alone. Available evidence suggests that definitive revascularization strategies significantly benefit appropriately selected elderly patients but have been underused. Guidelines in the management of the elderly patient with CAD will help to ensure that resources are rationed fairly and that interventions are directed at prolonging life with an improved state of health. The ultimate goal of revascularization in CAD is to optimize symptom-free survival at a reasonable cost and with minimal morbidity.