Older patients represent the majority of those considered for coronary intervention but they are under-represented in most clinical trials in this area. Reviewing registry data and pooled data from clinical trials, this article discusses the effect of age on procedural mortality and morbidity. It also reviews the effect of age on interventional procedures in unstable patients, and on pharmacological intervention. Despite the higher initial risks in older patients, the authors argue that several risk factors are responsible for predicting poor outcome following interventional procedures. Percutaneous coronary intervention can be very successful in the elderly and its risks must be balanced against the many important benefits older patients stand to gain from the procedure.