Objective To evaluate the efficacy and safety of bivalirudin in selective percutaneous coronary intervention (PCI) in elderly patients with unstable angina. Methods A total of 90 elderly unstable angina patients with age ranging from 60 to 75 years who received PCI in our hospital from November 2010 to March 2013 were enrolled in this study. They were prospectively divided into two matched groups: bivalirudin group (n＝47) and heparin sodium group (control, n＝43). The patients from bivalirudin group were designed to receive 0.75mg/kg of bivalirudin as loading dose before PCI, then followed by another injection of 0.3mg/kg if activated coagulation time (ACT) shorter than 225 sec five minutes later, and an intravenous injection of 1.75mg/(kg·h) till the end of operation. While, the patients from heparin sodium group had heparin sodium 100U/kg instead of bivalirudin, then another injection of 3000U for shorter ACT, and the other injection of 1000U if the operation did not end within one hour. The safety and efficacy outcome were evaluated by bleeding events and major adverse cardiac events (MACE) in 30d after PCI and ACT during PCI. Results There was no significant difference in the bleeding events and MACE in 30d between the two groups (P＞0.05). The efficiency was similar in the two groups. Conclusion Bivalirudin is safe and efficient in selective PCI of senile patients with unstable angina.