Objective To determine the effect of different education levels on the prognosis of coronary heart diseases in the elderly. Methods Totally 165 elderly patients with coronary angiography-identified acute coronary syndrome (ACS) in our department from January 2005 to January 2010 were enrolled in the study. A self-questionnaire about coronary heart disease was used on the initial admission to obtain the education level, as well as their understanding of coronary heart disease. Patients were divided into two groups according to their education level, the primary school and lower education level group (group A) and the junior high school or higher education level group (group B). The follow-up compliance, treatment compliance, cardiac function, and heart morphological changes were evaluated during the follow-up visit. Results Group A had a poorer follow-up compliance and treatment compliance than group B (P＜0.05). With the elapse of follow-up, group A also had worse deterioration of cardiac function and heart morphological changes, with significant differences between the two groups (P＜0.05). Conclusion There are significant differences in the prognosis among the elderly coronary heart disease patients with different education levels. The higher the education levels, the better their follow-up compliance and treatment compliance are.