An increasing number of octogenarians is being referred for coronary angiography with a view to myocardial revascularisation. Based on a retrospective study of 168 octogenarians undergoing coronary angiography between January 1987 and December 1992, the authors reviewed the indications, the risks and therapeutic decisions taken in those patients with significant coronary artery disease. The population studied had acute myocardial ischaemia in 88.7% of cases, a low incidence of previous myocardial infarction and severe extracardiac pathology. Significant coronary lesions were observed in 90% of patients (151) with multiple vessel diseases in 57.8% of cases. The mortality attributed to coronary angioplasty was 0.59% (1 case) and the morbidity was 4.7%. The number of disease vessels did not influence the decision as 75.5% of single vessel, 75% of double vessel and 77.3% of triple vessel disease patients were referred for coronary surgery or angioplasty. Of the patients undergoing a revascularisation procedure (n = 108), those referred for surgery (n = 22) had more severe coronary disease than those referred for angioplasty (p < 0.05). The hospital mortality was high about 8%, irrespective of the therapeutic decision. The 3 year actuarial survival was 70% in the group undergoing myocardial revascularisation (whether by angioplasty or coronary surgery) and 53.6% in subjects treated medically. These results show that coronary angiography in a selected elderly population is possible although the mortality and morbidity should not be underestimated. A high proportion of these patients (72%) is referred for myocardial revascularisation.