It is evident that our society has an increasing proportion of elderly population, because of a progressively longer life expectancy. That is why in our Cath labs we treat an increasing number of elderly patients every day. This patient profile has certain particularities that must be known to be able to approach more successfully the percutaneous revascularization procedures that they require and that can bring them a great prognostic benefit when properly indicated. However, the available clinical evidence is often limited due to a reduced representation of this population in clinical trials. Thus, we often have to resort to sub-analyses of trials or observational registries. In this chapter we address the assessment of clinical risk in these patients, either in stable or in acute unstable conditions. In this way we can estimate the benefit/risk ratio of coronary interventions and their appropriate timing. The assessment of bleeding risk on the one hand and ischemic-thrombotic risk on the other hand will be essential for an optimal management of these patients. We evaluate the clinical and anatomical characteristics of coronary artery disease in these patients and the implications that these have on the procedures in terms of the type of techniques to be used and how to apply them. Finally, we develop the specific aspects that the percutaneous coronary intervention presents in the different clinical contexts in which it may be indicated, as well as in the different lesional subsets.