Although the ability to document angina pectoris in the elderly patient may be compromised by atypical symptoms, limited activity levels, and blunted recall, anginal symptoms convey a similar adverse prognosis regardless of age. In general, the therapeutic approach to the older anginal patient should be dictated more by achievement of symptomatic relief than by considerations of long-term survival. No randomized trial exists to guide the decision of medical versus coronary artery bypass surgery versus angioplasty in the older patient with coronary artery disease; symptomatic relief, however, appears greater after revascularization procedures.