BACKGROUND Acute coronary syndrome (ACS) is a prevalent cardiovascular disease with persistent risks of myocardial under-perfusion and adverse events after percutaneous coronary intervention (PCI). The combination of tirofiban and cilostazol has shown potential efficacy, but clinical validation remains limited. This study evaluated the effects of tirofiban combined with cilostazol on cardiac function recovery and prognosis in elderly ACS patients after PCI. MATERIAL AND METHODS This study included 80 elderly ACS patients treated between April 2020 and April 2022. Patients were assigned to the control group (n=40), receiving aspirin and clopidogrel, or the observation group (n=40), receiving tirofiban and cilostazol after PCI. We assessed cardiac function, myocardial markers, serum inflammatory factors, platelet aggregation rate, platelet count (PLT), quality-of-life scores, and the incidence of major adverse cardiovascular events (MACE). RESULTS The treatment effectiveness was 97.50% in the observation group versus 80.00% in the control group. One month after PCI, the observation group had lower left ventricular end-diastolic diameter and left ventricular end-systolic diameter and higher left ventricular ejection fraction. Inflammatory markers (IL-6, hs-CRP, TNF-alpha), platelet aggregation rate, and PLT levels were significantly decreased. Myocardial markers (CK-MB, hs-cTnT) were elevated at 24 hours but improved by 1 month. Quality-of-life scores improved significantly, and MACE incidence was lower in the observation group. CONCLUSIONS Tirofiban combined with cilostazol enhances cardiac function, reduces inflammation, platelet aggregation, and myocardial injury, and improves prognosis in elderly ACS patients after PCI.