In greater than 25% of individuals with coronary artery disease (CAD), the obstruction in the artery is such that coronary angioplasty cannot be done. Eccentric morpho¬logy and ostial location increase the periprocedural risk. The presence of congestive heart failure or a low ejection fraction less than 30%, cardiogenic shock, renal insuffi¬ciency, multivessel CAD, and diabetes dictate a poor outcome, especially if a stent cannot be employed. The procedure is well tolerated in octogenarians, with single-vessel, discrete obstructive disease. Unfortunately, the increased prevalence of multivessel and diffuse disease and left ventricular dysfunction in the elderly diminishes the proportion of patients likely to have significant long-term benefits in comparison to surgery. PTCA and surgery are not competitive procedures and should be viewed as complementary.

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