Objectives: To predict the CAD in patients undergoing operation for mitral valve regurgitation, some logistic regression models have been established for the patients suffered from degenerative valve disease. In patients with rheumatic heart valve disease(RHVD), the risk of coexistent CAD is low and therefore the models might not be applicable for prediction. In this article, we sought to develop a logistic model that estimates the risk of significant CAD in elder patients undergoing operations for RHVD. Methods: A total of 585 elder patients who underwent routine coronary angiography before heart valve operations for RHVD between 1998 and 2009 were analyzed. A bootstrap logistic regression model on the basis of clinical risk factors was developed to identify low-risk (＜5%) patients. Receiver operating characteristic (ROC) curves were used to compare discrimination. Results: Independent predictors of coronary artery disease include age, male sex, angina, hypertension, and hypercholesterolemia. According to the logistic model, 155 patients were designated as low risk. Of these patients, only 4 (2.6%) had single-vessel disease, and none had multivessel disease. The model showed better discrimination than those established ones, with an area under the ROC curve of 0.793. Conclusion: Our model can reliably estimate the prevalence of significant CAD in elder patients before heart valve operations for RHVD. Low-risk patients can be identified in whom routine preoperative angiography may be safely avoided.