Objective To compare the clinical efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting(CABG) for octogenarians with chronic total occlusion of the left anterior descending artery. Methods From January 2016 to July 2020, a total of 73 octogenarians with chronic total occlusive disease of the left anterior descending artery who received interventional therapy and CABG in our hospital were enrolled in the study, in which 42 patients received interventional therapy and 31 patients underwent CABG. The clinical characteristics and incidence of major adverse cardiac events (including death, recurrence of angina pectoris and revascularization due to ischemia) during the hospitalization and one-year follow-up period were recorded in detail. Results There was no significant difference between two groups in age, gender composition, smoking, hypertension, diabetes, hyperlipidemia, stroke, history of myocardial infarction, history of previous PCI, history of peripheral vascular disease and SYNTAX score(all P>0.05). There was no significant difference between two groups in the rate of successful revascularization (90.5% vs 97.1%, P=0.473), and the rate of target vessel revascularization during one-year follow up period (7.89% vs 2.86%, P=0.667). Compared with the CABG group, the cost of the PCI group [(73 400±15 400) CNY vs (11 7700±13 400) CNY, P=0.000] and length of hospital stay in [(4.62±0.67) d vs (10.00±1.90) d, P=0.000] were significantly lower. Conclusions The PCI and CABG are two effective revascularization methods for octogenarians with chronic total occlusion of the left anterior descending artery. Compared with CABG, PCI is less expensive and the length of hospital stay is shorter.