〔Abstract〕 Objective To analyze the effect of percutaneous coronary intervention in the treatment of elderly acute non-ST segment elevation myocardial infarction (NSTEMI). Methods A total of 88 elderly patients with acute NSTEMI admitted to the First People's Hospital of Shangqiu from August 2021 to June 2023 were retrospectively selected. According to different treatment methods, 40 patients receiving conservative treatment were selected as a control group, and 48 patients receiving percutaneous coronary intervention on the basis of the control group were selected as an observation group. The clinical efficacy, cardiac function indexes, heart failure indexes, liver and kidney function indexes, and cardiovascular adverse events were compared and observed between the two groups. Results The total clinical effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the levels of left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and B-type natriuretic peptide (BNP) in the observation group were lower than those in the control group, and left ventricular ejection fractions (LVEF) was higher than that in the control group, with statistical significances (P < 0.05). After treatment, there was no significant difference in the levels of serum alanine aminotransferase (ALT) and serum creatinine (Scr) between the two groups (P > 0.05). The total incidence of cardiovascular adverse events in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Percutaneous coronary intervention in elderly patients with acute NSTEMI can enhance clinical outcomes, improve cardiac function, reduce BNP levels, and reduce the occurrence of adverse cardiovascular events.