Objective To investigate the clinical features and related risk factors of coronary tortuosity in elderly patients. Methods A total of 304 elderly patients, with age over 60 years, including 157 males and 147 females, who underwent coronary angiography in our department during January to June 2010 were enrolled in this study. Coronary angiography and clinical data of all patients were retrospectively reviewed to analyze risk factors and correlation of blood pressure and severity of coronary tortuosity. Results Positive rate of coronary tortuosity was 55.3%(168/304) in the cohort of elderly patients, but the incidence for women was 60.12% (101/168). Moderate tortuosity was most common in the left circumflex coronary artery (33.9%). Those with triple-vessel lesions had highest score in tortuosity severity. Gender and blood pressure were the risk factors of coronary tortuosity for the elderly patients. A significant positive correlation was found between blood pressure and coronary tortuosity severity. Conclusion Elderly patients have a high incidence of coronary tortuosity, which have an intimate correlation with gender and blood pressure. The higher the blood pressure is, the more severe the coronary tortuosity.