Objective To analyze the relationship between the changes of uric acid, carotid intima-media thickness (IMT) and the prognosis of elderly patients with coronary heart disease (CHD). Methods The 103 CHD patients admitted to our hospital from September 2017 to September 2019 were selected, including 30 patients with stable angina pectoris (SAP) and 36 patients with unstable angina pectoris (UAP),and 37 patients with acute myocardial infraction (AMI),which were classified as SAP group, UAP group and AMI group respectively. At the same time, 105 patients with normal results admitted to this hospital suspected coronary heart disease were selected as the control group. The differences in blood uric acid, IMT, and plaque index in all subjects were compared. All patients with CHD underwent percutaneous coronary intervention (PCI). Multivariate Logistic regression analysis was used to analyze the risk factors of cardiovascular events in CHD patients after PCI treatment. Pearson was used to analyze the correlation between blood uricacid and IMT. Results The blood uric acid level of the study group was higher than that of the control group, and the IMT and plaque index were higher than those of the control group (P＜0.05). The order of the three groups according to blood uric acid level, IMT and plaque index in descending order were AMI group, UAP group, and SAP group. The pairwise comparison of the three groups was statistically significant (P＜0.05). There were 42 patients with cardiovascular events in 103 patients with CHD after PCI treatment. BMI, number of diseased branches, blood lipids, blood creatinine, uric acid level, IMT, plaque index abnormalities were significantly related to the occurrence of cardiovascular events in CHD patients after PCI treatment (P＜0.05). Abnormal blood lipids, IMT, and plaque index were multiple factors that affected the occurrence of cardiovascular events in CHD patients after PCI treatment (P＜0.05). IMT had positive correlation with blood uric acid level (P＜0.05). Conclusion The serum uric acid level of elderly patients with CHD is positively correlated with IMT. Both of them are independent risk factors affecting cardiovascular events after PCI treatment, and can be used as effective indicators i clinical evaluation of the prognosis of CHD patients.