Changing population demographics dictate that in the next decade physicians will be increasingly faced with treating coronary artery disease in the elderly. Despite this, there is a paucity of data to guide management decisions in this population. Currently, it appears that "low-risk" or mild coronary artery disease can be treated medically so long as appropriate adjustments are made for aging changes in renal function, hepatic metabolism, noncompliance, multisystem disease, etc. Unfortunately, most elderly patients have "high-risk" or severe coronary artery disease. Balloon dilatation can yield excellent results in certain highly selected "high-risk" patients, but its role in the frequently encountered multivessel disease patient is unclear until current studies are completed. Coronary bypass grafting in selected patients clearly prolongs survival, but careful patient selection and meticulous preoperative and postoperative is required. Finally, the importance of issues such as quality of life, function independence, and cost must be addressed in more detail if physicians are to make rational decisions in treating this expanding population.