Objective To investigate the potential myocardial protective effects of etomidate target controlled infusion (TCI) combined with epidural anesthesia in elderly patients with coronary heart diseases. Methods Ninety elderly patients with ASAⅡor Ⅲ undergoing elective abdominal surgery were randomly divided into three group (n=30 each ): groupⅠ(propofol TCI), groupⅡ (etomidate TCI), and group Ⅲ (etomidate TCI with epidural anesthesia). SBP, DBP and cTnI were recorded and analyzed before anesthesia (T₀), during induction (T₁), after extubation (T₂), 6 h (T₃), 24 h (T₄)and 48 h (T₅) after operation, electrocardiogram was recorded, including various electrocardiographic changes in ST-T. Results SBP and DBP significantly lower in groupsⅡ and Ⅲ at T₁ than those in group Ⅰ(P<0.01),HR at the T₃ to T₅ was obviously faster in groups Ⅰand Ⅱthan that in group Ⅲ (P<0.05).CTnI at T₂ to T₅ was significantly lower in group Ⅲ than that group Ⅰ (P<0.05),and the change of ST-T in electerocardiogram was observed more obious groups Ⅰand Ⅱthan that in group Ⅲ (P<0.05). Conclusions Combined etomidate TCI with epidural anesthesia in elderly patients with coronary heart diseases could reduce the elevation of postoperative level of cTnT, which indicated the poential protective on myocardium.