Objective To investigate the efficacy of coronary rotational atherectomy in the treatment of severe coronary artery calcification in the elderly. Methods Eighty patients with coronary heart diseases admitted in our department from January 2014 to January 2016 were recruited in this study. They were randomly divided into 2 groups, rotational atherectomy group (n=40) and non-rotational atherectomy group (control, n=40). Their operation and perioperative complications were observed and compared between the 2 groups. Results The immediate success rate was significantly higher in the rotational atherectomy group than in the control group (92.50% vs 70.00%, P<0.05). The postoperative left ventricular ejection fraction were significantly increased when compared with that before treatment (P<0.05). There were 2 cases of ventricular fibrillation and 1 case of cardiac arrest in the rotational atherectomy group, but no acute myocardial infarction, cardiac death, coronary perforation or other complications were found. No perioperative complication was observed in the control group. Conclusion Rotational atherectomy has good efficacy in the treatment of severe coronary artery calcification in the elderly.