Objective To investigate the efficacy and safety of ticagrelor in elderly patients with non-ST-segment elevation acute coronary syndrome. Methods Tow hundred and two consecutive elderly non-ST-elevation acute coronary syndrome patients were enrolled in our hospital from January 2014 to June 2015. Patients were divided into two groups according to antiplatelet strategies. Ticagrelor group (n=86) were given ticagrelor (180mg loading dose, 90mg twice daily) while clopidogrel group (n=116) were given clopidogrel (300mg loading dose, 75mg daily). All patients were followed 12 months post-PCI for main adverse cardiac and cerebral events(MACCEs), recurrent myocardial ischemia and bleeding events. Results The MACCEs occurred in fewer patients in the ticagrelor group (n=4) than in the clopidogrel group(n=16) (P=0.030). The bleeding events of the ticagrelor group is higher than clopidogrel group(8.1% vs 6.8%). But there was no difference between two groups in the rate of total bleeding(P=0.752). Conclusion In elderly patients with NSTE-ACS received percutaneous coronary intervention, treatment with ticagrelor as compared with clopidogrel significantly reduced the MACCE without an increase in the rate of bleeding risk.