Objective To investigate the features of cardiopulmonary exercise testing (CPET) in elderly patients with coronary arterial disease (CAD). Methods A prospective study was carried out on the elderly patients who hospitalized and underwent coronary angiography and CPET in our center from October 2010 to October 2014. Those patients with acute myocardial infarction, pulmonary disease, left ventricular ejection fraction less than 55% or anaemia were excluded. The obtained 47 patients were divided into CAD (n＝33) and non-CAD groups (n＝17) according to the results of coronary angiography. Valuables of CPET were compared between the 2 groups of patients. Results The cohort was at an age of (62.6±4.3) years, and included 33 males and 15 females. There was no significant difference in gender, age, body mass index, and histories of cigarettes, hypertension and diabetes. No obvious difference was either seen in left ventricular end diastolic diameter (LVEDD) or left ventricular ejection fraction. CPET results showed that peak VO2 and percentage of it to expected value were lower in CAD group than in non-CAD group [(1 158.4±286.4) vs (1 382.2±337.9)ml/min], (60.5±13.4)% vs (83.6±14.5)%, P＜0.05]. Peak VO2/HR was also lower in the former than in the latter group [(9.5±1.5) vs (10.7±1.6)ml/(min·beat), P＝0.038). Compared with non-CAD group, VO2/WR slope was decreased in CAD group [(7.8±0.9) vs (6.5±1.5)ml/(min·W)]. However, there was no difference in anaerobic threshold (AT) or ventilatory equivalent ratio of oxygen and carbon dioxide (VE/VCO2) between the 2 groups. Conclusion Exercise tolerance is decreased in the elderly CAD patients than those without CAD, which may be associated with lower cardiac output for left ventricular dysfunction due to myocardial ischemia.