Objective To investigate the characteristics of coronary lesions in the patients older than 80 years with coronary heart disease (CHD) in order to provide the clinical basis for the treatment of CHD. Methods A total of 48 senior patients (over 80 years old, the very aged group) and 260 old patients (65 to 79 years old, the aged group) with coronary heart disease admitted to our department from January 2013 to December 2015 were enrolled in this study. The risk factors, distribution of coronary lesions segments, Gensini scores of coronary lesions, and incidences of complications were compared between the 2 groups. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The incidence rates of acute myocardial infarction, old myocardial infarction, high blood pressure, diabetes, hypercholesteremia, and cerebral infarction were significantly higher in the males from the very aged group than the aged group(P<0.05). Most patients of the very aged group suffered from muti-vessel lesions, and had high incidences of left main coronary artery and chronic occlusion lesion, and higher Gensini score than the aged group(P<0.05). There were no significant differences in the occurrences of peri-operative and intra-operative complications between the 2 groups, but the very aged patients presented an increasing trend in peri-operative mortality rate. Conclusion The very aged patients with CHD have more clinical risk factors and underlying diseases than the aged ones, with complicated coronary lesions and more serious coronary artery stenosis. Comprehensive assessment should be carried out for the benefit and risk of surgery in the very aged patients with CHD in order to implement a safer and more effective treatment plan.