Objective To study the incidence rate and risk factors of gastrointestinal major bleeding in patients with coronary artery disease treated with elective percutaneous coronary intervention (PCI). Methods 4239 patients with coronary artery disease successfully treated with elective PCI were divided into gastrointestinal major bleeding group and non-gastrointestinal bleeding group. Results The gastrointestinal major bleeding was found in 47 (1.1%) of 4239 patients; The mortality in the gastrointestinal major bleeding group was higher than non-gastrointestinal bleeding group (6.4% vs 3.2%; P<0.0001). Multivariate logistic regression analysis revealed that advanced age (>75years old, OR＝1.246, 95％CI 1.026～1.439; P＝0.031), anemia (OR＝1.182, 95％CI 1.026～1.339; P＝0.037), history of gastrointestinal hemorrhage (OR＝1.494，95％CI 1.124～1.865，P＝0.005), and chronic renal insufficiency (OR＝2.271, 95％CI 2.158～2.403; P＝0.001) were independent predictors of gastrointestinal major bleeding in patients treated with elective PCI. Conclusion Advanced age, anemia, history of gastrointestinal bleeding and chronic renal insufficiency are independent predictors of gastrointestinal major bleeding in patients with coronary artery disease treated with elective PCI.