Abstract: Objective To study the characteristics of coronary artery in advanced age patients with acute coronary syndrome (ACS), the relation of ACS with its risk factors, and its management. Methods 536 ACS patients at the age ≥ 80 years and 568 ACS patients at the age of 60~70 years were included in this study. Their clinical data characteristics of coronary artery and management were compared. The patients were divided in 4 groups according to the number of stenosis arteries. Relation of the number of stenosis arteries with risk factors was analyzed. Results The systolic blood pressure(SBP), fasting blood glucose (FBG), and serum creatinine levels, the proportion of complications including hypertension, diabetes mellitus(DM), stroke and chronic renal insufficiency, and the number of lesions in multi-vessels, left main branch(LM), left anterior descending branch(LAD), right coronary artery(RCA)were significantly higher in patients at the age ≥ 80 years (P< 0.01). Aspirin and clopidogrel were commonly used while β receptor blocker and angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB) were less used in treatment of the patients(P< 0.01). The heart rate(HR), SBP, FBG, serum creatinine(SCR) and estimated glomerular filtration rate (eGFR)were significantly different in the 4 groups. The stenosis proportion of LM, LAD, left circumflex branch(LCX) and RCA, and the proportion of severe stenosis and total occlusion increased with the number of stenosis branches (P< 0.01). Conclusion Lesions of coronary artery in advanced age ACS patients are complicated and accompany with many diseases. HR, SBP, FBG, SCR and eGFR are the risk factors for ACS and related with the number of stenosis arteries.