Percutaneous coronary intervention (PCI) is a key treatment modality for acute and chronic coronary syndromes. However, clinical decision-making becomes significantly complex in elderly patients aged above 75 due to frailty, multiple co-morbidities, cognitive impairment, high bleeding risk, vascular calcification, and reduced physiological reserve. This study evaluates safety profiles, mortality rates, procedural risks, and outcome predictors in elderly patients undergoing PCI. A retrospective cohort of 412 elderly patients (≥75 years) was analyzed over five years across tertiary cardiac centers. Findings indicate higher in-hospital mortality (5.6%) and increased vascular complications (11.3%) compared to younger cohorts (≤65 years: 2.1% and 3.4% respectively). However, when performed with radial access, optimal antithrombotic strategies, and minimal contrast use, PCI demonstrated favorable survival and symptom improvement. The study concludes that PCI remains safe but requires geriatric-adaptive protocols.