Objective To determine the effect of anxiety and depression on the incidence of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in the elderly patients with coronary heart diseases. Methods A total of 400 patients with coronary heart diseases who underwent PCI in our hospital from March 2012 to September 2015 were recuited in this study. According to the results of self rating anxiety scale and self rating depression scale in 7 to 14 d after PCI, the patients were divided into anxiety and depression group (with anxiety and/or depression, n=88) and control group (n=279). The incidence of MACE within 1 year after PCI was compared between the 2 groups. Multiple logistic regression analysis was used for the relationship of anxiety and depression with the occurrence of MACE. Results The MACE incidence was 25.00% in the anxiety and depression group, significantly higher than that in the control group (13.98%, Chi square=5.864, P=0.015). Stepwise forward logistic regression analysis indicated that high-density lipoprotein cholesterol reduction (OR=0.692), more branches of coronary artery lesions (OR=2.987), depression and anxiety (OR=2.164) were independent risk factors for MACE in the elderly patients with coronary heart disease after PCI (P<0.05). Conclusion Anxiety and depression increase the risk of MACE in elderly patients with coronary heart disease after PCI.