Objective To investigate the therapeutic effect of coronary rotational atherectomy on elderly patients with coronary heart disease and coronary artery calcification. Methods A total of 104 elderly patients with coronary heart disease and coronary artery calcification who were admitted to our hospital from January to December 2021 were enrolled, and according to whether coronary rotational atherectomy was performed, they were divided into control group (54 patients receiving conventional interventional therapy) and observation group (50 patients receiving coronary rotational atherectomy in addition to conventional interventional therapy). The two groups were compared in terms of cardiac ejection fraction (EF) and target vessel lumen diameter before and after treatment, postoperative complications, and the incidence rate of major adverse cardiovascular events (MACE) at 12 months after surgery. Results There were no significant differences between the two groups in age, sex, smoking history, hypertension, diabetes mellitus, cardiac EF, and target vessel lumen diameter (P>0.05), and after surgery, the observation group had significantly better cardiac EF and target vessel lumen diameter than the control group (P<0.05). There were no significant differences between the two groups in the incidence rates of postoperative complications (coronary artery dissection, perforation, coronary slow flow, and arrhythmia) (P>0.05), and there were also no significant differences between the two groups in the incidence rates of MACE events (cardiac death, nonfatal myocardial infarction, stent thrombosis, and target vessel revascularization) at 12 months after surgery (P>0.05). Conclusion For the elderly patients with coronary heart disease and coronary artery calcification, coronary rotational atherectomy can effectively improve coronary artery stenosis and cardiac function with a favorable safety profile, and therefore, it holds promise for wide clinical application.