What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?  

I would do everything I could with respect to medical and lifestyle therapy for such a patient. They are at very high risk for a bad outcome in the cath lab. 

Excellent question but the context required for an answer for the right approach.Is this patient ambulatory, or symptomatic?Or was admitted with ACS or other cardiac decompensating event and workup resulted in finding multi V CAD?A nice article in recent JAAC on Norwegian octogenarians tried to answ...