Background: The long-term mortality, thrombotic risk and bleeding complications of very old patients (>= 80 years) with atrial fibrillation (AF) and coronary stenting were less studied. Methods: We enrolled 1504 patients >= 65 years with nonvalvular AF undergoing coronary stenting between January 2010 and June 2015 from 12 hospitals in Beijing, China. Results: 164 patients (10.9%) had ages >= 80 years. Very old patients had higher prevalence of cardiac dysfunction, renal dysfunction (RD, creatinine clearance < 60 ml/min), anemia and acute ST segment elevation myocardial infarction (STEMI) than younger patients. The mean follow-up duration was 39.0 +/- 18.7 months. Complete follow-up data was obtained for 94.3% of the whole cohort. Very old patients had higher mortality (22.8% vs. 10.6%, p < 0.001), more major adverse cardiac/cerebro-vascular events (MACCE, 33.6% vs. 18.5%, p < 0.001), and major bleeding events (MB) (5.4% vs. 2.8%, p = 0.150) than younger controls. For very old patients, multivariate Cox regression identified cardiac dysfunction (HR: 2.564, 95% CI: 1.279-5.139, p = 0.008), RD (HR: 4.001, 95% CI: 1.518-10.546, p = 0.005) and STEMI (HR: 2.529, 95% CI: 1.275-5.013, p = 0.008) as independent predictors for all-cause death; cardiac dysfunction (HR: 2.590, 95% CI: 1.470-4.565, p = 0.001) and RD (HR: 4.204, 95% CI: 1.865-9.476, p = 0.001) as independent predictors for MACCE; cardiac dysfunction (HR: 2.417, 95% CI: 1.399-4.176, p = 0.002), RD (HR: 4.278, 95% CI: 1.997-9.164, p < 0.001) and STEMI (HR: 1.767, 95% CI: 1.008-3.097, p = 0.047) as independent predictors for the composite endpoint of MACCE and MB. Conclusion: Very old patients with AF and coronary stenting had a poor long-term prognosis, with cardiac dysfunction and RD as independent risk factors. Copyright (C) 2019, Taiwan Society of Geriatric Emergency & Critical Care Medicine.