Reminiscence therapy (RT) promotes cognitive and psychological health in elderly individuals. This study assessed the impact of the reminiscence therapy-involved care program (RTIC) on cognition, anxiety, depression, and satisfaction among patients with elderly acute coronary syndrome (ACS) who received percutaneous coronary intervention (PCI).In total, 152 elderly patients with ACS undergoing PCI were randomized into the RTIC (n = 76) and routine care (RC) (n = 76) groups to receive the corresponding 6-month interventions. The mini-mental state examination (MMSE) scores were evaluated at discharge (M0), 3rd month (M3), and 6th month (M6). The hospital anxiety and depression scale for anxiety/depression (HADS-A/HADS-D) and patient satisfaction scores were assessed at M0, 1st month (M1), M3, and M6.The MMSE score at M6 (27.6 ± 2.0 versus 26.7 ± 2.1, P = 0.011) increased, whereas the percentage of cognitive impairment at M6 (27.9% versus 44.8%, P = 0.042) declined in the RTIC group versus the RC group. Moreover, the RTIC group achieved a low HADS-D score at M3 (6.5 ± 2.0 versus 7.4 ± 2.6, P = 0.035) and M6 (6.3 ± 1.9 versus 7.2 ± 2.5, P = 0.016), but a similar HADS-A score and percentages of depression and anxiety at any assessment point versus the RC group. Patient satisfaction at M3 (82.3 ± 12.0 versus 77.7 ± 11.4, P = 0.020) and M6 (85.6 ± 11.0 versus 79.4 ± 12.0, P = 0.002) was higher in the RTIC group than in the RC group. In the subgroup analysis, patients with and without cognitive impairment at M0 and those with depression at M0 benefited from RTIC. RTIC promotes cognition, psychological health, and satisfaction among elderly patients with ACS undergoing PCI.