Objective To observe the clinical features of the elderly coronary heart diseases (CHD) patients who had underwent percutaneous coronary intervention (PCI), and analyze the gender differences in risk factors for CHD and the prognosis after PCI. Methods A total of 4 927 elderly CHD patients (＞65 years old) who had underwent PCI in Shenyang General Hospital of Shenyang Military Command from July 2008 to November 2012 were enrolled in this study. There were 3 049 males and 1 878 females in this retrospective study. Clinical features, coronary angiographic results, PCI outcomes, peri-operative medications of antithrombotic agents and other cardiovascular drugs, and incidence of in-hospital major adverse cardiocerebrovascular events (MACCE) were collected and analyzed for gender differences and clinical features. Results Among the risk factors for CHD, the prevalence of smoking and the morbidity of renal dysfunction were significantly higher in the males than in the females (51.5% vs 15.3%, P＜0.01; 22.1% vs 15.3%, P＜0.01). While, the women had higher body mass index (BMI) [(24.8±4.4) vs (24.5±3.7)kg/m2, P＜0.05], older age of onset [(72.6±4.8) vs (72.2±5.4) years, P＜0.01], and higher proportion of morbidities such as hypertension and diabetes (70.5% vs 60.8%, P＜0.01; 32.2% vs 24.9%, P＜0.01) than the men. There was no significant difference in the overall incidence of in-hospital MACCE between the male and female patients. However, the females had significantly higher mortality than the males (0.6% vs 0.1%, P＜0.01). Conclusion The elderly female CHD patients undergoing PCI have severer burden of risk factors and poor prognosis than their male counterparts.