Objective To evaluate the correlation between serum level of uric acid and severity of coronary lesions in elderly patients with coronary heart disease. Methods A cohort of 289 elderly patients with age over 70 years suffering from angiographically identified coronary artery disease (diameter stenosis ≥50% of lumen narrowing) admitted to our department from January 2011 to August 2012 were enrolled in this study. The severity of coronary artery disease was assessed by Gensini score. Preoperative serum uric acid level was measured with an automatic biochemical analyzer. The correlation of serum uric acid level with the extent and severity of coronary stenosis was analyzed. Results There was no significant difference in serum level of uric acid among the single-, double- and multiple-vessel lesion groups [(0.358±0.102) vs (0.379±0.112) vs (0.366±0.112), P＞0.05]. No significant difference was seen in serum level of uric acid among the senile with different severity of coronary artery stenosis [(0.360±0.100) vs (0.375±0.119) vs (0.369±0.100) vs (0.370±0.123), P＞0.05]. There was no significant difference in the severity of coronary artery stenosis (Gensini score) between normal uric acid group and hyperuricemia group [(37.138±24.934) vs (41.887±35.294), P＞0.05]. For male and female patients, there was still no significant difference in serum uric acid levels among the single-, double- and multiple-vessel lesion groups. The patients with different Gensini scores had no significant difference in serum uric acid level. Conclusion No adequate evidence shows that serum uric acid level can be used as a risk factor or predictor for the severity of coronary lesions among elderly patients with coronary heart disease.