Objective To compare the prognostic impact of different revascularization strategies, multi-staged versus single-staged percutaneous coronary intervention (PCI) in the elderly patients with non-ST elevation acute coronary syndrome (NSTE-ACS) complicated with multivessel disease (MVD). Methods A retrospective study was carried out on 110 elderly patients [67 males and 43 females, at an age of (63.1±8.5)years] suffering from NSTE-ACS complicated with MVD who were admitted in our department from June 2016 to January 2017. According to the revascularization, they were divided into single-staged PCI group (n=48) and multi-staged PCI group (n=62). The data of PCI and incidences of complications and major adverse cardiovascular events (MACEs) during hospitalization were observed and compared between the 2 groups. In the end of the 6 months’ follow-up, heart function, relief of angina symptoms, and occurrence of MACEs were compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. Student’s t test or Chi-square test was adopted for the comparison between the 2 groups. Results There were no significant differences in left ventricular ejection fraction (LVEF) and the in-hospital global registry of acute coronary events (GRACE) risk score before the operation between the 2 groups (P>0.05). The multi-staged PCI group had less usage of contract in coronary angiography [(180.0±60.0) vs (230.0±70.0) ml, P=0.04], and lower incidences of in-hospital MACEs[1.6%(1/62) vs 10.4%(5/48), P=0.04] and complications [4.8%(3/62) vs 18.8%(9/48), P=0.02] when compared with the single-staged PCI group. The occurrence of MACEs was also lower in the multi-staged group than the single-staged group in the end of follow-up[4.9%(3/61) vs17.4%(8/46), P=0.03]. Conclusion Multi-staged PCI is safe and effective for revascularization, and it might be an optimal strategy for the elderly NSTE-ACS patients complicated with MVD.