Background Thus far, the outcome and effect of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery on the quality of life of octogenarian patients has not been accurately assessed in Japan. Methods and Results A retrospective analysis of the outcome of invasive coronary revascularization in 130 elderly patients (age, ≥80 years) with ischemic coronary disease was carried out. Their current quality of life was determined by the Seattle Angina Questionnaire. Although the in-hospital death rate was relatively high (21.6% after PCI and 14.3% after CABG surgery), the long-term outcome of the patients who did not die during the in-hospital period after the PCI/CABG surgery was acceptable (5-year survival rate, >60%). All domains of the questionnaire received a favorable score from a majority of the survivors, irrespective of the treatment they received. Conclusions The quality of life and longevity of the octogenarian patients following extensive invasive revascularization for ischemic coronary artery disease were satisfactory. (Circ J 2007; 71: 847 - 854)