A more conserva- tive approach to coronary angiography is often appropriate given the higher risk of contrast-induced nephropathy in older adults.1161 Moreover, the risks of morbidity and mortality associated with CABG are increased in older adults. Despite the complexities and concerns related to evaluating and treating elderly patients with SIHD, findings from the COURAGE trial indicated that initial medical therapy was not significantly less effective than medical therapy plus PCI in relieving angina (73% in the GDMT group at 60 months, versus 80% in the medical therapy plus PCI group).1162 Although the mortality rate was 50% higher among patients .65 years of age than among younger patients, there were no significant differences between the 2 treatment groups in either patients younger or older than 65 years. Furthermore, although the incidence of MI and stroke was also higher in older patients, there were no significant differences between treatment groups. In the TIME (Trial of Invasive versus Medical Therapy in the Elderly) trial, 301 patients $75 years of age with chronic angina with CCS Class II or higher despite treatment with $2 antianginal drugs were randomized to GDMT or to an invasive strategy of coronary angiography followed by revascularization with PCI or CABG, if feasi- ble.1163 Patients who were assigned to the early revascular- ization group experienced greater improvement in symptoms at 6 months. This difference disappeared by 12 months, at which time both groups had shown a 2-class improvement in their CCS scores and similar results on other quality-of-life measures. It should be noted that 45% of the group assigned to medical therapy ultimately underwent revascularization because of refractory symptoms. 