Aim To investigate the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and perioperative myocardial injury (PMI) in elderly patients with coronary heart disease and its predictive value. Methods From January 2016 to June 8,0 elderly patients with coronary heart disease who underwent PCI in our hospital were included in the study. Baseline data of patients were collected, and cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP), Lp-PLA2 and other biochemical parameters were measured before and after PCI operation. According to whether cTnT was elevated or not after PCI operation, the patients were divided into control group (55 cases without elevation of cTnT) and observation group (45 cases with elevation of cTnT). Clinical data and intraoperative status of PCI were compared between the two groups. Logistic regression was used to analyze the risk factors of PMI.Results There were no significant differences in hypertension, diabetes, smoking, PCI, statins use, high density lipoprotein cholesterol, low density lipoprotein cholesterol, creatinine and N-terminal pro-B-type natriuretic peptide between the two groups (P＞0.05). The level of apolipoprotein B in observation group was higher than that in control group (P＜0.05). The levels of Lp-PLA2 and hs-CRP in the observation group were significantly higher than those in the control group (P＜0.05). Gensini integral, stent number, stent release pressure and operation time in observation group were significantly higher than those in control group (P＜0.05). Logistic regression analysis showed that Lp-PLA2 (OR 4.5,5%CI 1.43-14.47), Gensini score (OR 1.8,5%CI 1.01-1.14), stent number (OR 5.5,5%CI 2.04-14.01) and operation time (OR 1.6,5%CI 1.00-1.12) were risk factors for PMI. Conclusion Preoperative elevation of Lp-PLA2 is a risk factor for PCI-related myocardial injury in elderly patients with coronary heart disease and has predictive value for PMI.