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.
