Will coronary artery bypass grafting remain a standard of care for elderly patients with multivessel disease in the contemporary era?

Advanced age plays an important role in the pathogenesis of atherosclerosis.Therefore, older individuals with coronary artery disease tend to have more complex lesions (e.g.left main coronary artery disease or multivessel disease) than younger individuals.However, many randomised trials have excluded elderly patients based on their age or associated comorbidities, making it unclear what the optimal treatment strategy is for elderly patients with complex coronary artery disease.A higher prevalence of concomitant diseases and increased frailty may make clinicians hesitate to opt for a high-risk invasive strategy, such as cardiac surgery, and instead select a less invasive treatment, because of the potentially higher risk of periprocedural complications.In this issue of the Netherlands Heart Journal, Gimbel et al. report that in their retrospective cohort of patients aged ≥75 years with multivessel disease or left main coronary artery disease, coronary artery bypass grafting (CABG) was associated with significantly lower risks of mortality, acute coronary syndrome, repeat revascularisation and recurrent angina than percutaneous coronary intervention (PCI) [1].In this trial, the completeness of revascularisation was not independently associated with the outcomes.However, the complete revascularisation rate was rel-