Abstract: Objective To explore the application value of percutaneous coronary intervention (PCI) in the treatment of elderly patients with sarcopenia and ischemic cardiomyopathy (ICM). Methods A total of 129 elderly patients with sarcopenia and ICM were selected as study subjects and randomly divided into conventional group (64 patients) and combined group (65 patients) using a random number table method. After screening based on exclusion criteria, 55 patients were ultimately included in each group. The conventional group received conventional drug therapy, while the combined group received PCI in addition to conventional therapy. Subjective symptoms, blood pressure systolic blood pressure (SBP), diastolic blood pressure (DBP), New York Heart Association (NYHA) functional class, Canadian Cardiovascular Society (CCS) angina class, left ventricular function indicators left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), serological indicators N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), creatine kinase-MB (CK-MB), and 6-minute walk distance (6MWD) were compared between the two groups at admission and 1-, 3-, and 6-month after discharge. Additionally, the incidence of major adverse cardiovascular events (MACE) was observed in both groups. Results All 55 patients in the combined group underwent PCI with implantation of 1 stent to 3 stents, with an average of (1.78±0.36) stents implanted per patient, and the surgical success rate was 100.00%. At 1-, 3-,and 6-month after discharge, the scores for chest pain, palpitations, chest distress, and fatigue, as well as SBP, DBP, NYHA functional class, and CCS angina class, were lower in both groups compared to admission. Furthermore, these indicators were lower in the combined group than in the conventional group at 3 and 6 months after discharge (P<0.05). At 1-, 3-, and 6-month after discharge, LVEDD and LVESD were smaller, LVEF was higher, and serum levels of NT-proBNP, cTnT, and CK-MB were lower in both groups compared to admission. Additionally, LVEDD, LVESD, and serum levels of NT-proBNP, cTnT, and CK-MB were lower, and LVEF values were higher in the combined group than those in the conventional group at 3 and 6 months after discharge (P<0.05). The 6MWD was longer in both groups at 1-, 3-, and 6-month after discharge compared to admission, and the combined group was longer than that in the conventional group at 3 and 6 months after discharge (P<0.05). At 6 months after discharge, the incidence of MACE was lower in the combined group than in the conventional group (P<0.05). Conclusion The application of PCI in the treatment of elderly patients with sarcopenia and ICM can significantly improve subjective symptoms and objective cardiac function indicators, and reduce the incidence of MACE.