Coronary heart disease (CHD) in the elderly is featured with systemic atherosclerosis background, multiple cardiovascular risk factors, several chronic diseases and(or) multiple organ dysfunctions, atypical symptoms and diffuse and extensive lesions. Attention should be paid to the control of the relative risk factors and physical exercise and diet intervention. As for treatment of stable CHD, optical medical therapy(OMT) is strongly recommended according to COURAGE research, including anti-platelet therapy, lipid regulation, and anti-hypertensive and anti-anginal agents, not underestimating the effect of beta receptor blockers and resin angiotensin system inhibitors; and the therapeutic efficiency of percutaneous coronary intervention (PCI) is not inferior to that of coronary artery bypass grafting (CABG). For treatment of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), anti-platelet and anti-thrombotic therapy is firstly recommended; drugs, including prasugrel, GP Ⅱb/Ⅲa receptor inhibitors, fondaparinux sodium, bivalirudin, and rivaroxaban, should be selected rationally, considering their different effects on reducing major adverse cardiac events (MACE) and hemorrhage risk; PCI at early stage exerts superior effect on high-risk patients. As for treatment of ST-segment elevation acute myocardial infarction (AMI), PCI is the first choice, except for the patients with definite contraindications; thrombolytic therapy is quite efficient for the patient without contraindication, but special caution should be paid for intracranial hemorrhage, a devastating complication. Currently, correlation of gene polymorphism with CHD in the elderly and new diagnosis and monitoring technology are now drawing attention.