Background: Percutaneous coronary intervention (PCI) outcomes in elderly people are more challenging due to several factors. This study aimed to investigate in-hospital and short-term outcomes of PCI in elderly people aged more than 65 years old, presented to cardiology department of Tanta university hospitals during study period. Methods: This case-control study was carried out on 935 patients presenting for elective PCI procedure and those suffering from high-risk ACS either ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina treated with urgent PCI. Patients were divided into 4 groups: group II: included 326 patients aged from 65 to 69 years old, group III: included 160 patients aged from 70 to 74 years old, group IV: Included 99 patients aged ≥ 75 years old and group I (control): included 350 patients aged < 65 years old. All patients were subjected to ECG, echocardiography, basic labs, coronary angiography and PCI. Results: Mortality, dissection, perforation, CIN, hemorrhage, heart failure and cardiogenic shock were significantly different among STEMI patients’ groups (P ≤ 0.05). CVS, Heart failure and Cardiogenic shock were significantly different among NSTE-ACS patients’ groups (P ≤ 0.05). Loss of follow up and mortality were significantly different among NSTE-ACS patients’ groups. Age, diabetes mellitus, hypertension, multi-vessel diseases, dissection, perforation and major bleeding were significant predictors of mortality among elective PCI patients (P ≤ 0.05). Age, diabetes mellitus, hypertension, chronic kidney diseases that necessitates dialysis, dyslipidemia multi-vessel diseases, left main artery, final TIMI 0, final TIMI I dissection, perforation, and major bleeding were significant predictors of mortality among ACS PCI patients (P ≤ 0.05). Conclusions: In spite that PCI in elderly people still challenging, with poorer outcomes especially among those older than 75 years of age, newer generations of drug-eluting stents, and wide-availability of the safer radial artery access reduced the risk of PCI-related major adverse cardiovascular events and improved the long-term clinical outcomes in elderly patients suffering from both high-risk chronic and ACS.